Efficacy of pharmacologic closure of patent ductus arteriosus in small-for-gestational-age extremely preterm infants
Nansi S Boghossian, Barbara T Do, Edward F Bell, John M Dagle, Jane E Brumbaugh, Barbara J Stoll, Betty R Vohr, Abhik Das, Seetha Shankaran, Pablo J Sanchez, Myra H Wyckoff, M Bethany Ball, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Nansi S Boghossian, Barbara T Do, Edward F Bell, John M Dagle, Jane E Brumbaugh, Barbara J Stoll, Betty R Vohr, Abhik Das, Seetha Shankaran, Pablo J Sanchez, Myra H Wyckoff, M Bethany Ball, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Abstract
Background: Optimal management of the patent ductus arteriosus (PDA) in preterm infants remains controversial. Therefore, studies identifying infants who are most likely to benefit from PDA treatment are needed.
Aim: We sought to examine if significant intrauterine growth restriction, defined by birth weight z-score, reduces the efficacy of PDA closure with indomethacin or ibuprofen and thereby increases the need for surgical closure of PDA after pharmacologic treatment.
Study design, subjects, and outcome measures: We studied infants 23-28weeks' gestation born 2006-2013 at NICHD Neonatal Research Network centers. We examined the responses to PDA treatment with indomethacin and/or ibuprofen and whether the PDA was subsequently closed surgically. Logistic regression generated adjusted odds ratios (ORs) for the associations between the z-score groups (<-2, -2 to -0.5, and >-0.5) and PDA surgery following pharmacologic treatment.
Results: 5606 infants were diagnosed with PDA; 3587 (64.0%) received indomethacin or ibuprofen or both, and 909 (25.3%) underwent PDA surgery. Mothers of infants with PDA non-closure were less likely to have hypertension (19% vs. 28%). Infants with non-closure were more likely to be female (53% vs. 49%), have lower gestational age and birth weight and to develop sepsis (42% vs. 31%). Compared to infants with z-score>-0.5, PDA surgery was increased among infants with z-score -2 to -0.5 (OR=1.23; 95% CI 1.02-1.47) but not among infants with z-score<-2.
Conclusion: Infants with birth weight z-score -2 to -0.5 are more likely than normally grown infants to require PDA surgery following pharmacologic treatment.
Trial registration: ClinicalTrials.gov NCT00063063 NCT00009633.
Keywords: Ibuprofen; Indomethacin; Morbidity; Mortality; Premature infants.
Conflict of interest statement
CONFLICT OF INTEREST
None declared.
Copyright © 2017 Elsevier B.V. All rights reserved.
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Source: PubMed