Spontaneous Closure of Patent Ductus Arteriosus in Infants ≤1500 g

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OBJECTIVES: Patent ductus arteriosus (PDA) remains a challenging issue in very low birth weight (VLBW) infants, and its management varies widely. Our aim in this study was to document the natural course of ductus arteriosus in a cohort of VLBW infants who underwent conservative PDA management with no medical or surgical intervention.

METHODS: A retrospective cohort study conducted in 2 European level-3 neonatal units.

RESULTS: A total of 368 VLBW infants were born within the study period. Two hundred and ninety-seven infants were free of congenital malformations or heart defects and survived to hospital discharge. Out of those, 280 infants received truly conservative PDA management. In 237 (85%) of nontreated infants, the PDA closed before hospital discharge. The Kaplan-Meier model was used to document the incidence proportion of PDA closure over time for different gestational age groups. The median time to ductal closure was 71, 13, 8, and 6 days in <26+0, 26+0 to 27+6, 28+0 to 29+6, and ≥30 weeks, respectively. For different birth weight groups, the median was 48, 22, 9, and 8 days in infants weighing <750, 750 to 999, 1000 to 1249, and 1250 to 1500 g, respectively. No statistically significant relationship was found between PDA closure before hospital discharge and neonatal morbidities.

The likelihood of PDA spontaneous closure in VLBW infants is extremely high. We provide in our findings a platform for future placebo-controlled trials focused on the smallest and youngest infants.

Reference: Jana Semberova, Jan Sirc, Jan Miletin, Jachym Kucera, Ivan Berka, Sylva Sebkova, Sinead O’Sullivan, Orla Franklin, Zbynek Stranak. Spontaneous Closure of Patent Ductus Arteriosus in Infants ≤1500 g. Pediatrics, Jul 2017, e20164258; DOI:10.1542/peds.2016-4258