Natural evolution of ductus arteriosus with noninterventional conservative management in extremely preterm infants born at 23-28 weeks of gestation

• Published in: PloS one Vol. 14; no. 2; p. e0212256
• Main Authors: Sung, Se In, Chang, Yun Sil, Kim, Jisook, Choi, Jin Hwa, Ahn, So Yoon, Park, Won Soon
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 13.02.2019; Public Library of Science (PLoS)
• Subjects: Age; Analysis; Biology and Life Sciences; Birth weight; Congenital diseases; Congenital heart defects; Conservative Treatment; Coronary vessels; Dependence; Disease; Ductus Arteriosus - physiopathology; Ductus Arteriosus, Patent - mortality; Ductus Arteriosus, Patent - physiopathology; Ductus Arteriosus, Patent - therapy; Evolution; Female; Follow-Up Studies; Gestation; Gestational Age; Health aspects; Humans; Hypotheses; Incidence; Infant; Infant Mortality; Infant, Extremely Premature; Infant, Newborn; Infants; Male; Medical records; Medicine; Medicine and Health Sciences; Morbidity; Mortality; Newborn babies; Patent ductus arteriosus; Pediatrics; Pregnancy; Premature babies; Premature infants; Regression analysis; Research and Analysis Methods; Respiratory distress syndrome; Retrospective Studies; Risk; Risk Factors; Subgroups; Ventilators
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0212256

This study aimed to determine the natural course of patent ductus arteriosus (PDA) with noninterventional conservative management and whether the presence and/or prolonged duration of hemodynamically significant (HS) PDA increased the risk of mortality and morbidities in extremely preterm (EPT) infants. We retrospectively reviewed the medical records of EPT infants born at 23-28 weeks of gestation (n = 195) from January 2011 to June 2014, when PDA was managed with noninterventional conservative treatment. We stratified infants into three subgroups of 23-24, 25-26, and 27-28 weeks and analyzed the prevalence and natural evolution of HS PDA, defined as ventilator dependency and PDA size ≥2 mm. Multivariate regression analyses determined if the presence and/or prolonged duration of HS PDA increased the risk for mortality and/or morbidities. The overall incidence of HS PDA was 57% (111/195) at the end of the first postnatal week. In subgroup analyses, infants with 23-24 weeks of gestation had the highest incidence (93%, 50/54), with 64% (47/74) for 25-26 weeks and 21% (14/67) for 27-28 weeks. Six (5%) of 111 infants with HS PDA were discharged without ductus closure, 4 had spontaneous PDA closure on follow up, and device closure was performed for 2 infants. In the multivariate analyses, the presence or prolonged duration (per week) of HS PDA was not associated with the risk of mortality and/or morbidities. Spontaneous closure of HS PDA was mostly achieved, even in EPT infants, with a noninterventional conservative approach. In conclusion, our data showed the incidence and natural course of HS PDA in EPT infants and suggested that the presence or prolonged duration of HS PDA might not increase the rate of mortality or morbidities.