060 - Trends in the Management of Patent Ductus Arteriosus Refractory to Medical Treatment in Preterm Infants

Publication Number: 60.6819

Marwa M. Elgendy, University of Florida, Jacksonville, FL, United States; Josef Cortez, UF Health Jacksonville, Jacksonville, FL, United States; Mohsen A.A.. Farghaly, Cleveland Clinic Children's, Cleveland, OH, United States; Kevin M. Vogt, University of Florida College of Medicine, ponte vedra, FL, United States; Hany Aly, Cleveland Children’s Hospital, Cleveland, OH, United States; Mohamed A. Mohamed, Cleveland Clinic Children's, Cleveland, OH, United States

Background: Management of hemodynamically significant patent ductus arteriosus (PDA) in preterm infants continues to be challenging. Treatment strategies for PDA closure in preterm infants who do not respond to medical therapy have evolved over time. Expectant management with no further intervention has been shown to be non-inferior to medical treatment with a prostaglandin inhibitor. Recently, the introduction of less invasive transcatheter device closure (TCC) has emerged as an alternative to surgical closure. However, TCC availability has been limited to specific centers in the United States.

Objective: To investigate trends and outcomes in managing PDA in very low birth weight (VLBW) infants, comparing expectant management, surgical ligation, and transcatheter closure in recent years.

Design/Methods: The National Inpatient Sample (NIS) dataset produced by the Healthcare Cost and Utilization Project (HCUP) for the years 2016-2020 has been used in this analysis. Eligible cases were identified using the International Classification of Diseases – Version 10 (ICD10). Infants < 1500g at birth were included. PDA was identified using the ICD10 code Q25.0. For PDA surgical ligation the codes 02LR0ZT, 02LR0CT, and 02LR0DT were used. For Transcatheter device closure the codes 02LR3CT, 02LR3DT, 02LR3ZT, 02LR4CT, 02LR4DT, and 02LR4ZT were used. Changes in trends were examined using the chi-square test for trends. Adverse outcomes were compared between TCC and surgery groups using logistic regression models.

Results: The analysis included a total of 261,047 VLBW infants of whom 69,008 (26.4%) had PDA. Surgery was performed on 5,024 (7.28%) infants with PDA, while 1,366 infants (1.98%) underwent TCC. Among the overall sample of VLBW infants, the prevalence of active closure of PDA using either surgery or TCC has declined from 2.76% in 2016 to 2.10% in 2020 with a statistically significant change in trend. Surgical closure declined by more than 50%, from 2.54% to 1.09%, p< 0.01, while TCC increased almost 5-fold, from 0.22% to 1.01%, p < 0.01 (Figure 1). Infants managed with TCC had less sepsis or acute kidney injury (AKI) compared to those who had surgery, but there was no difference regarding the incidence of necrotizing enterocolitis (NEC) or mortality between groups (Table 1).

Conclusion(s): The overall trend to actively pursue interventions for closing PDA refractory to medical treatment has decreased over the past five years. During this period, the rate of surgical PDA ligation has declined, while transcatheter closure (TCC) has increased. TCC has been associated with fewer adverse outcomes compared to surgical intervention.

Figure (1): Change in the management of refractory patent ductus arteriosus over the years


Adverse outcomes in infants managed with transcatheter patent ductus arteriosus (PDA) closure versus surgical PDA ligation.