Retrospective comparison of death or neurodevelopmental outcomes in extremely low birth weight preterm infants following different management options of haemodynamically significant patent ductus arteriosus
Abstract Background Optimal management of haemodynamically significant patent ductus arteriosus (HsPDA) in premature babies remains controversial. Our aim is to compare death and/or adverse neurodevelopmental outcomes in extremely low birth weight (ELBW) infants with HsPDA who were managed with cons...
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| Format: | Article |
| Language: | English |
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BMC
2021-10-01
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| Series: | BMC Pediatrics |
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| Online Access: | https://doi.org/10.1186/s12887-021-02920-9 |
| _version_ | 1829491120814424064 |
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| author | Jania Jia-Ying Wu Krishnamoorthy Niduvaje Le ye Lee Zubair Amin |
| author_facet | Jania Jia-Ying Wu Krishnamoorthy Niduvaje Le ye Lee Zubair Amin |
| author_sort | Jania Jia-Ying Wu |
| collection | DOAJ |
| description | Abstract Background Optimal management of haemodynamically significant patent ductus arteriosus (HsPDA) in premature babies remains controversial. Our aim is to compare death and/or adverse neurodevelopmental outcomes in extremely low birth weight (ELBW) infants with HsPDA who were managed with conservative [C], medical [M] and/or surgical [S] treatment, with secondary aim to examine short-term morbidities among [S] and [C] groups. The study also compared outcomes in very low birth weight (VLBW) infants with HsPDA and non-HsPDA. Methods A retrospective study of VLBW preterm infants born before 29 weeks in Singapore from 2007 to 2016 was conducted. Results A total of 474 VLBW infants were admitted in NUH from 2007 to 2016. Infants aged between 24 + 0 and 28 + 6 weeks of gestation, weighing ≤1500 g and diagnosed with patent ductus arteriosus (PDA) were included in the study, of which 172 infants (124 HsPDA and 48 non-HsPDA) were analyzed. Among infants with HsPDA, 17 infants were managed with [C], 83 with [M] and 24 with [S]. Mortality was not increased regardless of the presence of HsPDA or treatment received. Infants with non-HsPDA were less likely to have isolated speech delay (p < 0.05), but not global developmental delay (GDD). No significant differences in neurodevelopmental outcomes such as hearing loss, cerebral palsy (CP) and speech delay were found. [M + S] infants were at a higher risk of developing chronic lung disease (CLD) (OR 6.83, p < 0.05) and short-term growth failure compared to [C] infants. They were significantly shorter and had a smaller head circumference at discharge (p < 0.05). [M + S] infants also had elevated creatinine compared to those in group [C] (81.1 ± 24.1 vs 48.3 ± 11.8 umol/L, p < 0.000). Conclusions Compared to conservative management, infants requiring [M + S] treatment for HsPDA were more likely to have short-term complications such as CLD, elevated creatinine, and poorer growth. Despite a more turbulent postnatal course, death and/or adverse neurodevelopmental outcomes were not worse in infants managed with [M + S]. |
| first_indexed | 2024-12-15T00:33:27Z |
| format | Article |
| id | doaj.art-2bd249a106f84892adc963d4eccc1baa |
| institution | Directory Open Access Journal |
| issn | 1471-2431 |
| language | English |
| last_indexed | 2024-12-15T00:33:27Z |
| publishDate | 2021-10-01 |
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| series | BMC Pediatrics |
| spelling | doaj.art-2bd249a106f84892adc963d4eccc1baa2022-12-21T22:41:53ZengBMCBMC Pediatrics1471-24312021-10-0121111010.1186/s12887-021-02920-9Retrospective comparison of death or neurodevelopmental outcomes in extremely low birth weight preterm infants following different management options of haemodynamically significant patent ductus arteriosusJania Jia-Ying Wu0Krishnamoorthy Niduvaje1Le ye Lee2Zubair Amin3Department of Paediatrics, Yong Loo Lin School of Medicine, National University of SingaporeDepartment of Paediatrics, Yong Loo Lin School of Medicine, National University of SingaporeDepartment of Paediatrics, Yong Loo Lin School of Medicine, National University of SingaporeDepartment of Paediatrics, Yong Loo Lin School of Medicine, National University of SingaporeAbstract Background Optimal management of haemodynamically significant patent ductus arteriosus (HsPDA) in premature babies remains controversial. Our aim is to compare death and/or adverse neurodevelopmental outcomes in extremely low birth weight (ELBW) infants with HsPDA who were managed with conservative [C], medical [M] and/or surgical [S] treatment, with secondary aim to examine short-term morbidities among [S] and [C] groups. The study also compared outcomes in very low birth weight (VLBW) infants with HsPDA and non-HsPDA. Methods A retrospective study of VLBW preterm infants born before 29 weeks in Singapore from 2007 to 2016 was conducted. Results A total of 474 VLBW infants were admitted in NUH from 2007 to 2016. Infants aged between 24 + 0 and 28 + 6 weeks of gestation, weighing ≤1500 g and diagnosed with patent ductus arteriosus (PDA) were included in the study, of which 172 infants (124 HsPDA and 48 non-HsPDA) were analyzed. Among infants with HsPDA, 17 infants were managed with [C], 83 with [M] and 24 with [S]. Mortality was not increased regardless of the presence of HsPDA or treatment received. Infants with non-HsPDA were less likely to have isolated speech delay (p < 0.05), but not global developmental delay (GDD). No significant differences in neurodevelopmental outcomes such as hearing loss, cerebral palsy (CP) and speech delay were found. [M + S] infants were at a higher risk of developing chronic lung disease (CLD) (OR 6.83, p < 0.05) and short-term growth failure compared to [C] infants. They were significantly shorter and had a smaller head circumference at discharge (p < 0.05). [M + S] infants also had elevated creatinine compared to those in group [C] (81.1 ± 24.1 vs 48.3 ± 11.8 umol/L, p < 0.000). Conclusions Compared to conservative management, infants requiring [M + S] treatment for HsPDA were more likely to have short-term complications such as CLD, elevated creatinine, and poorer growth. Despite a more turbulent postnatal course, death and/or adverse neurodevelopmental outcomes were not worse in infants managed with [M + S].https://doi.org/10.1186/s12887-021-02920-9Chronic lung diseaseConservative treatmentDeathExtremely preterm infantsNeurodevelopmental delay |
| spellingShingle | Jania Jia-Ying Wu Krishnamoorthy Niduvaje Le ye Lee Zubair Amin Retrospective comparison of death or neurodevelopmental outcomes in extremely low birth weight preterm infants following different management options of haemodynamically significant patent ductus arteriosus BMC Pediatrics Chronic lung disease Conservative treatment Death Extremely preterm infants Neurodevelopmental delay |
| title | Retrospective comparison of death or neurodevelopmental outcomes in extremely low birth weight preterm infants following different management options of haemodynamically significant patent ductus arteriosus |
| title_full | Retrospective comparison of death or neurodevelopmental outcomes in extremely low birth weight preterm infants following different management options of haemodynamically significant patent ductus arteriosus |
| title_fullStr | Retrospective comparison of death or neurodevelopmental outcomes in extremely low birth weight preterm infants following different management options of haemodynamically significant patent ductus arteriosus |
| title_full_unstemmed | Retrospective comparison of death or neurodevelopmental outcomes in extremely low birth weight preterm infants following different management options of haemodynamically significant patent ductus arteriosus |
| title_short | Retrospective comparison of death or neurodevelopmental outcomes in extremely low birth weight preterm infants following different management options of haemodynamically significant patent ductus arteriosus |
| title_sort | retrospective comparison of death or neurodevelopmental outcomes in extremely low birth weight preterm infants following different management options of haemodynamically significant patent ductus arteriosus |
| topic | Chronic lung disease Conservative treatment Death Extremely preterm infants Neurodevelopmental delay |
| url | https://doi.org/10.1186/s12887-021-02920-9 |
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