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Clinical Trial
. 2019 Feb 13;14(2):e0212256.
doi: 10.1371/journal.pone.0212256. eCollection 2019.

Natural evolution of ductus arteriosus with noninterventional conservative management in extremely preterm infants born at 23-28 weeks of gestation

Se In Sung  1 , Yun Sil Chang  1 , Jisook Kim  1 , Jin Hwa Choi  1 , So Yoon Ahn  1 , Won Soon Park  1
Affiliations
Clinical Trial

Natural evolution of ductus arteriosus with noninterventional conservative management in extremely preterm infants born at 23-28 weeks of gestation

Se In Sung et al. PLoS One. .

Abstract

This study aimed to determine the natural course of patent ductus arteriosus (PDA) with noninterventional conservative management and whether the presence and/or prolonged duration of hemodynamically significant (HS) PDA increased the risk of mortality and morbidities in extremely preterm (EPT) infants. We retrospectively reviewed the medical records of EPT infants born at 23-28 weeks of gestation (n = 195) from January 2011 to June 2014, when PDA was managed with noninterventional conservative treatment. We stratified infants into three subgroups of 23-24, 25-26, and 27-28 weeks and analyzed the prevalence and natural evolution of HS PDA, defined as ventilator dependency and PDA size ≥2 mm. Multivariate regression analyses determined if the presence and/or prolonged duration of HS PDA increased the risk for mortality and/or morbidities. The overall incidence of HS PDA was 57% (111/195) at the end of the first postnatal week. In subgroup analyses, infants with 23-24 weeks of gestation had the highest incidence (93%, 50/54), with 64% (47/74) for 25-26 weeks and 21% (14/67) for 27-28 weeks. Six (5%) of 111 infants with HS PDA were discharged without ductus closure, 4 had spontaneous PDA closure on follow up, and device closure was performed for 2 infants. In the multivariate analyses, the presence or prolonged duration (per week) of HS PDA was not associated with the risk of mortality and/or morbidities. Spontaneous closure of HS PDA was mostly achieved, even in EPT infants, with a noninterventional conservative approach. In conclusion, our data showed the incidence and natural course of HS PDA in EPT infants and suggested that the presence or prolonged duration of HS PDA might not increase the rate of mortality or morbidities.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Initial incidence of HS-PDA, HIS-PDA, and early closure at the end of the first postnatal week according to gestational age subgroup.
GA, gestational age; HS-PDA, hemodynamically significant patent ductus arteriosus; HIS-PDA, hemodynamically insignificant patent ductus arteriosus.
Fig 2
Fig 2. Cumulative incidence rate of ductal patency during hospitalization in infants with initial HS PDA according to gestational age group.
PDA, patent ductus arteriosus; GA, gestational age.
See this image and copyright information in PMC

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