770 - Evaluating the Effectiveness of Pharmacological Treatment of PDA After One Week Postnatal Age

Publication Number: 770.4819

Anita Narkhede, USF Health Morsani College of Medicine, Tampa, FL, United States; Alexandra Hoeman, USF Health Morsani College of Medicine, Tampa, FL, United States; Keyur Donda, University of South Florida, Brandon, FL, United States; Thao Ho, University of South Florida, Tampa, FL, United States

Background: A patent ductus arteriosus (PDA) can be closed with pharmacological treatments. Previous studies have primarily investigated pharmacological treatment during the first week of life, and there are more studies using non-steroidal anti-inflammatory drugs (NSAIDs), indomethacin and ibuprofen, than acetaminophen. However, there is minimal data regarding the effectiveness of pharmacological treatment beyond the first week of life. There has also been a shift in treatment practices toward using acetaminophen for PDA closure rather than NSAIDs, despite limited evidence supporting its effectiveness.

Objective: To compare the effectiveness of pharmacological treatments of PDA (indomethacin, acetaminophen, and ibuprofen) after one week of life in the closure of PDA in preterm infants.

Design/Methods: This is a retrospective chart review of 178 neonates with gestational age at birth < 33 weeks or birth weight < 1500 g admitted to a level III NICU from 2013-2023 with echocardiographic evidence of PDA who received initial medication treatment one week or more after birth. Data extracted from the electronic medical record included gestational age, treatment type, day of life at treatment, and PDA size on echocardiogram before and after treatment. We compared the proportion of patients with physical PDA closure, defined as no or trivial PDA on follow-up echocardiogram, after one and two treatment courses across medications using chi-square tests. Multinominal logistic regression analysis was performed to evaluate the factors predicting PDA closure in this population.

Results: In this unit, there has been an increasing trend in using acetaminophen for PDA closure (Figure 1). PDA closure after one course and two courses of treatment were significantly higher in patients who received indomethacin compared to ibuprofen or acetaminophen (33.7% v. 13.6% v. 13.5%, p = 0.038, and 46% v. 23% v. 19%, p = 0.010, respectively) (Figure 2). Medication choice was a significant predictor of PDA closure when controlling for gestational age and day of life at treatment, (X2 = 16.611, p = 0.002).

Conclusion(s): Indomethacin was more effective in promoting PDA closure after the first week of life compared to ibuprofen and acetaminophen in preterm infants. The findings suggest that indomethacin remains the most effective pharmacological option for treating PDA regardless of gestational age and day of life at treatment. Future research may include investigating short-term and long-term outcomes of PDA treatment options after the first week of life.

Figure 1. Trend in medication usage for PDA treatment in a Level III NICU from 2013-2023


Figure 2. Comparing the effectiveness of medications in PDA closure in preterm infants after one week of life