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. 2021 Jan 5:8:605879.
doi: 10.3389/fped.2020.605879. eCollection 2020.

Related Factors of Patent Ductus Arteriosus in Preterm Infants: A Systematic Review and Meta-Analysis

Chang Liu  1   2   3 , Xingwang Zhu  1   2   3 , Dinggang Li  1   2   3 , Yuan Shi  1   2   3   4
Affiliations

Related Factors of Patent Ductus Arteriosus in Preterm Infants: A Systematic Review and Meta-Analysis

Chang Liu et al. Front Pediatr. .

Abstract

Background: Patent ductus arteriosus (PDA) is a dramatically harmful disease in the neonatal period, in particular common in preterm infants, and our study was to determine related factors of PDA in preterm infants. Methods: A comprehensive literature review was conducted in PubMed, EMBASE, and Web of Science. The pooled odds ratio and standard mean difference were calculated to compare dichotomous and continuous variables, respectively. In addition, we also assessed the heterogeneity and publication bias and carried out sensitivity analysis for each related factor. Results: We included 45 studies with 87,419 individuals. After the primary analysis and a series of adjustments, results showed chorioamnionitis, lower gestational age, lower birth weight, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, respiratory distress syndrome, sepsis, surfactant treatment, ventilation, and lower platelet count had a positive correlation with PDA, while small for gestational age decreased the incidence of PDA in preterm infants. Besides, premature rupture of membranes, preeclampsia, antenatal steroids, male gender, mean platelet volume, and platelet distribution width were found to have no statistically significant relationship with PDA. Conclusion: Preterm infants with more immature characteristics generally have a higher likelihood to develop PDA. The prevention, diagnosis, and management of PDA may depend on these results, and effective measures can be taken accordingly.

Keywords: meta-analysis; patent ductus arteriosus; preterm infants; related factors; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram describing the systematic review of related factors of patent ductus arteriosus in preterm infants.
Figure 2
Figure 2
Results of maternal factors in primary analysis. (A) Forest plot of association between PDA and chorioamnionitis; (B) funnel plot for publication bias of the association between PDA and chorioamnionitis; (C) forest plot of association between PDA and premature rupture of membranes; (D) forest plot of association between PDA and preeclampsia; (E) forest plot of association between PDA and antenatal steroids (according to unadjusted data); (F) funnel plot for publication bias of the association between PDA and antenatal steroids (according to unadjusted data); (G) forest plot of association between PDA and antenatal steroids (according to adjusted data). PDA, patent ductus arteriosus.
Figure 3
Figure 3
Results of neonatal characteristics in primary analysis. (A) Forest plot of association between PDA and gestational age; (B) funnel plot for publication bias of the association between PDA and gestational age; (C) forest plot of association between PDA and birth weight; (D) funnel plot for publication bias of the association between PDA and birth weight. PDA, patent ductus arteriosus.
Figure 4
Figure 4
Results of neonatal characteristics in primary analysis. (A) Forest plot of association between PDA and small for gestational age; (B) funnel plot for publication bias of the association between PDA and small for gestational age; (C) forest plot of association between PDA and male gender (according to unadjusted data); (D) funnel plot for publication bias of the association between PDA and male gender (according to unadjusted data); (E) forest plot of association between PDA and male gender (according to adjusted data). PDA, patent ductus arteriosus.
Figure 5
Figure 5
Results of complications in primary analysis. (A) Forest plot of association between PDA and bronchopulmonary dysplasia; (B) funnel plot for publication bias of the association between PDA and bronchopulmonary dysplasia; (C) forest plot of association between PDA and intraventricular hemorrhage; (D) funnel plot for publication bias of the association between PDA and intraventricular hemorrhage; (E) forest plot of association between PDA and necrotizing enterocolitis; (F) funnel plot for publication bias of the association between PDA and necrotizing enterocolitis. PDA, patent ductus arteriosus.
Figure 6
Figure 6
Results of complications in primary analysis. (A) Forest plot of association between PDA and sepsis; (B) forest plot of association between PDA and respiratory distress syndrome (according to unadjusted data); (C) funnel plot for publication bias of the association between PDA and respiratory distress syndrome; (D) forest plot of association between PDA and respiratory distress syndrome. PDA, patent ductus arteriosus.
Figure 7
Figure 7
Results of treatment in primary analysis. (A) Forest plot of association between PDA and surfactant treatment; (B) funnel plot for publication bias of the association between PDA and surfactant treatment; (C) forest plot of association between PDA and ventilation. PDA, patent ductus arteriosus.
Figure 8
Figure 8
Results of laboratory examination in primary analysis. (A) Forest plot of association between PDA and mean platelet volume; (B) forest plot of association between PDA and platelet distribution width; (C) forest plot of association between patent ductus arteriosus PDA and platelet count. PDA, patent ductus arteriosus.
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