Current Status of Therapeutic Strategies for Patent Ductus Arteriosus in Very-Low-Birth-Weight Infants in Korea

Abstract

This study aimed to investigate current therapeutic strategies for patent ductus arteriosus (PDA) in very-low-birth-weight (VLBW) infants in Korea. A total of 2,254 VLBW infants among 2,386 from Korean Neonatal Network cohort born from January 2013 to June 2014 were included. No PDA was seen for 1,206 infants (53.5%) and the infants diagnosed or treated for PDA were 1,048 infants (46.5%). The proportion of infants with PDA was decreased according to the increase in gestational age (GA) and birthweight. Infants with PDA were divided into groups according to the therapeutic strategies of PDA: prophylactic treatment (PT, n = 69, 3.1%), pre-symptomatic treatment (PST, n = 212, 9.4%), symptomatic treatment (ST, n = 596, 26.4%), and conservative treatment (CT, n = 171, 7.6%). ST was the most preferred treatment modality for preterm PDA and the proportion of the patients was decreased in the order of PST, CT, and PT. Although ST was still the most favored treatment in GA < 24 weeks group, CT was more preferred than PST or ST when compared with GA ≥ 32 weeks group [CT vs. PST, OR 5.3, 95% CI 1.56-18.18; CT vs. ST, OR 2.9, 95% CI 1.03-8.13]. A total of 877 infants (38.9%) received pharmacological or surgical treatment about PDA, and 35.5% (801 infants) received pharmacological treatment, mostly with ibuprofen. Seventy-six infants (3.4%) received primary ligation and 8.9% (201 infants) received secondary ligation. Diverse treatment strategies are currently used for preterm PDA in Korea. Further analyses of neonatal outcomes according to the treatment strategies are necessary to obtain a standardized treatment guideline for preterm PDA.

Keywords: Korea; Patent Ductus Arteriosus; Treatment; Very-Low-Birth-Weight Infant.

Fig. 1. Study population. A total of 2,254 very-low-birth-weight (VLBW) infants registered in the Korean Neonatal Network (KNN) from 2013.1. to 2014.6. were included. "No PDA group" was 1,206 patients (53.5%) and "PDA group" was 1,048 patients (46.5%).

Fig. 2. Preterm patent ductus arteriosus (PDA) treatment. Proportion of patients who received pharmacological (with or without surgery) and surgical treatment (both primary and secondary ligation) was decreased with the increase in gestational age and birthweight. (A) According to the gestational age, (B) According to the birthweight.

Fig. 3. Proportion of patients according to the postnatal days of the first day of patent ductus arteriosus (PDA) treatment (Proportion of patients in each treatment modality: pharmacological treatment, primary ligation, and secondary ligation). Mean postnatal days at the first dose of pharmacological treatment was 4.6±6.4 days. Mean postnatal days of surgery was 10.9±10.4 days in primary ligation group and 21.3±16.2 days in secondary ligation group.