244 - Exposure to a Hemodynamically Significant Patent Ductus Arteriosus and Feeding Outcomes in Very Preterm Infants. A Retrospective Cohort Study

Publication Number: 4240.244

Ana Nevarez Gilbert, University of Iowa, Iowa City, IA, United States; Samuel Wong, University of Iowa, Iowa City, IA, United States; Tarah Colaizy, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States; Aamer Imdad, university of, Iowa City, IA, United States; Adrianne R. Bischoff, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States

Background: The presence of a patent ductus arteriosus (PDA) increases morbidity and mortality in extremely preterm infants. Additionally, PDA decreases post-ductal systemic perfusion and poses major nutritional challenges with gastrointestinal complications such as feeding intolerance, intestinal perforation, and necrotizing enterocolitis. While PDA is a recognized risk factor for delayed enteral feeding and prolonged hospitalization, research exploring PDA severity, duration, and feeding advancement during treatment remains limited

Objective: To identify the association of duration of exposure to a hemodynamically significant PDA (hsPDA) with the achievement of oral independence at 36-, 38-weeks PMA, at discharge, and overall length of hospital stay

Design/Methods: Retrospective cohort analysis of infants born at ≤30 weeks gestation at the University of Iowa NICU from January 1, 2019, to June 30, 2024. hsPDA was defined by the Iowa PDA score ≥ 6 in conjunction with treatment. Descriptive statistics were used for demographics and feeding milestones. Univariable analyses were used to assess demographics and outcomes, followed by multivariable logistic regression. The study was approved by the University of Iowa IRB

Results: In univariable analyses, hsPDA was significantly associated with lower odds of oral feeding independence at 36 weeks (OR 0.23, 95% CI 0.13-0.42), 38 weeks (OR 0.40, 95% CI 0.27-0.60), and at discharge (OR 0.59, 95% CI 0.35-0.99). When modeled as a binary exposure, significance remained only at 38 weeks (OR 0.96, 95% CI 0.935-0.986, p = 0.003), and persisted after adjusting for gestational age, birthweight, gender and BPD (OR 0.96, 95% CI 0.931-0.993, p = 0.018). Longer exposure to hsPDA was linked to delays in feeding milestones and longer hospitalization: each additional day was associated with a 0.56- day delay in PO initiation (p < 0.001), 0.35-day delay in full oral feeds (p = 0.023), and a 0.65 day increase in length of stay (p = 0.002)

Conclusion(s): The presence of a hsPDA was not significantly associated with oral feeding independence at 36-, 38-weeks PMA or discharge after adjustment for clinical covariates. However, longer duration of exposure to a hsPDA independently predicted delayed initiation and attainment of full oral feeds and prolonged hospitalization, even after adjusting for gestational age, birthweight, gender, and BPD

Iowa PDA scoring system
Table 1: echocardiographic measurements used at the University of Iowa Hemodynamics Program to assess for clinical significance of PDA

Association of Duration of Exposure to hsPDA and Feeding Independence at Three Timepoints
Table 2: Comparison of univariable and multivariable OR to evaluate association of duration of exposure to hsPDA and feeding independence at three timepoints

Duration of Exposure to hsPDA and length of Hospital Stay
Scatter Plot to portray the association between duration of exposure to hsPDA and length of hospital stay