420 - The Association Between Patent Ductus Arteriosus and Hepatic Cholestasis Among Very Low Birth Weight Infants.

Publication Number: 420.6898

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

Background: Patent ductus arteriosus (PDA) may be associated with reduced blood flow to the abdominal aorta and hypo-perfusion of the abdominal organs. Others have hypothesized that significant PDA may be associated with necrotizing enterocolitis (NEC). It is not known if PDA is associated with other adverse outcomes related to gastrointestinal organs.

Objective: To examine the association of PDA with hepatobiliary cholestasis in very low birth weight (VLBW) infants.

Design/Methods: We examined the National Inpatient Sample dataset produced by the Healthcare Cost and Utilization Project for 2016-2020. We used the International Classification of Diseases-version 10 (ICD10) codes to identify clinical diagnoses in the sample. We included VLBW infants (birthweight < 1500g). We identified PDA using the ICD10 code Q25.0 and hepatic cholestasis using the code P78.89. We excluded infants with congenital heart disease, diaphragmatic hernia, abdominal wall defects, multiple congenital anomalies, and those who died within the first 48 hours of life. We used logistic regression models to calculate adjusted odds ratios (aOR) controlling for confounding factors. We used the chi-square test for trends to examine changes over time.

Results: The sample included 166,742 VLBW infants. There were 27,289 (16.4%) infants with PDA and 1785 (1.07%) with cholestasis. The diagnosis of PDA decreased over recent years from 16.9% in 2016 to 14.6 in 2020 (p < 0.01) while the diagnosis of cholestasis increased from 0.62% in 2016 to 1.32% in 2020 (p < 0.01). The rate of cholestasis among VLBW infants with PDA was 1.58% compared to 0.97% in infants without PDA (OR 1.64, 95% CI:1.47-1.83, p< 0.001). Other variables associated with cholestasis were BW < 1000g, maternal hypertension, maternal diabetes mellitus, chorioamnionitis, and ventilation duration (p < 0.001). After controlling for confounders (sex, race/ethnicity, BW < 1000g, maternal and placental factors, pulmonary hypertension, or sepsis), PDA was associated with cholestasis (aOR 1.31 95% CI 1.15-1.49, p< 0.001). Of note, race/ethnicity (African American, Hispanic/Latino, and Asian/Pacific Islander) was significantly associated with cholestasis compared to Caucasian (aOR, 1.28 (1.13-1.45), 1.50 (1.31-1.72), 1.66 (1.34-2.05) respectively).

Conclusion(s): In a large cohort of VLBW infants, after adjusting for potential confounders, PDA is linked to the development of cholestasis. Other independent factors may contribute to cholestasis, potentially through various mechanisms of hepatic injury. Further research is warranted to explore the racial disparities observed in the prevalence of cholestasis.