450 - Respiratory outcomes of hemodynamically significant PDA following transcatheter patent ductus arteriosus closure versus medical management

Publication Number: 3435.450

Dipen P. Vyas, University of Mississippi School of Medicine, Brandon, MS, United States; Timothy G. Martin, University of Mississippi School of Medicine, Pearl, MS, United States; Lores Sharp, University of Mississippi School of Medicine, Jackson, MS, United States; Danielle Bryant, University of Mississippi Medical Center, Jackson, MS, United States; Sunny Patel, University of Mississippi School of Medicine, Saltillo, MS, United States; Maher Ajour, University of Mississippi School of Medicine, Ridgeland, MS, United States

Background: Transcatheter Patent Ductus Arteriosus closure (TCPC) has been increasingly used in preterm infants in recent years. Studies have shown benefit and safety of TCPC over surgical ligation, but limited knowledge is available for its eligibility criteria, timing of TCPC, and long-term benefits over medical management (MM).

Objective: We hypothesized that in neonates born < 29 weeks (w) gestational age (GA), with hemodynamically significant Patent ductus arteriosus (hsPDA), TCPC will have a lower death or BPD rate compared to MM or TCPC+MM.

Design/Methods: A single-center retrospective chart review from 1/1/2020 to 2/28/2024 of neonates born < 29w GA was performed. Any PDA requiring intervention as per the neonatologist for closure was considered hemodynamically significant. Neonates with major congenital heart disease, pulmonary malformation, genetic defects, or outborn were excluded. Baseline characteristics, the primary outcome of death or BPD, and other respiratory comorbidities at discharge were compared between MM, TCPC only, and TCPC+MM.

Results: Of 395 neonates born < 29 w GA during the study period, 94 (23.8%) required intervention for PDA closure (MM 34, TCPC only 25, and TCPC+MM 35). Baseline characteristics were similar except for small for gestational age (SGA) (MM 11.8%, TCPC 48%, TCPC+MM 43%, p 0.004), post-natal steroid use (MM 8.8%, TCPC 52%, TCPC+MM 40%, p 0.004), and need for 1 or 2 inotropes in first month of age (Table 1). The average age of TCPC was 61 days with a SD of 26.2. Infants receiving MM had lower death or BPD rates than those receiving TCPC or MM+TCPC (MM 62%, TCPC 88%, TCPC+MM 82%, p < 0.001). MM group had lower Grade 3 BPD, grade 2-3 BPD, need for pulmonary hypertension medication, Gastrostomy tube, mechanical ventilation days, total duration of respiratory support, and length of stay compared to TCPC & TCPC +MM group (Table 2). Regression analysis showed higher odds of respiratory comorbidities in TCPC and TCPC + MM group compared to MM, which remained significant after adjusting for confounders GA, SGA, and ventilation at 2w of age (Table 3). There was no difference in outcomes between TCPC and TCPC + MM group.

Conclusion(s): In neonates born < 29w GA with hsPDA as determined by clinicians, infants undergoing TCPC had higher rates of death or BPD and respiratory morbidities at discharge compared to MM. Possible residual confounders and delayed use of TCPC may have impacted our findings. This study highlights the need for prospective trials focusing on eligibility criteria and long-term benefits of TCPC.

Demographics and Baseline Characteristics
Cat categorical, TCPC transcatheter PDA closure, PDA patent ductus arteriosus, Cr creatinine, PNS post-natal steroids, ROP retinopathy of prematurity, NEC necrotizing enterocolitis, IVH intraventricular hemorrhage
* Post hoc analysis performed using the Bonferroni correction and the Games-Howell test; letters a and b indicate groups that differ on post hoc analysis.

Primary and secondary outcomes
BPD bronchopulmonary dysplasia, PH pulmonary hypertension
* Post hoc analysis performed using the Bonferroni correction and the Games-Howell test; letters a and b indicate groups that differ on post hoc analysis.

Outcomes: Odds ratio and Confidence interval using regression models
BPD bronchopulmonary dysplasia, PH pulmonary hypertension, LFNC low flow nasal cannula, MV mechanical ventilation, RS respiratory support, IRR incidence rate ratio, OR odds ratio, CI confidence interval
Binary logistic regression for binomial variables, Ordinal logistic regression for grade of BPD, and Negative binomial regression for IRR.
multivariate analysis performed adjusting for GA, SGA, ventilation at 2 weeks of age