Clinical and Echocardiographic Factors Influencing Patent Ductus Arteriosus Treatment in Preterm Neonates

TL;DR

This study identifies clinical and echocardiographic factors that influence treatment decisions for patent ductus arteriosus in preterm neonates.

Contribution

The study reveals specific clinical and echocardiographic indicators that guide treatment choices for PDA in preterm infants.

Findings

Oliguria, inotropic drug use, low PDA flow velocity, and left atrial enlargement are linked to medical or surgical treatment decisions.

A low base deficit before medical therapy is associated with the need for surgery after treatment failure.

Comprehensive monitoring of clinical and echocardiographic factors can support treatment decisions for PDA in preterm neonates.

Abstract

Objective: We evaluated how pre-treatment clinical and echocardiographic findings influence treatment decisions for patent ductus arteriosus (PDA) in preterm neonates. Study Design: Preterm neonates weighing < 1500 g and diagnosed with PDA were enrolled. They were categorized into conservative, medical, and surgical groups based on treatment. Results: A total of 242 preterm neonates (120 boys and 122 girls) participated, with a mean gestational age of 27.9 ± 2.2 weeks and a birth weight of 1034.3 ± 239.3 g. Multivariate logistic regression revealed that oliguria (p < 0.001), inotropic drug use (p = 0.049), low PDA flow velocity (p = 0.039), and left atrial enlargement (p = 0.002) were significantly associated with medical or surgical treatment decisions. Additionally, a low base deficit prior to medical therapy was associated with the decision to proceed with surgical intervention after medical treatment failure (p = 0.006). Conclusions: Oliguria, inotropic drug use, low PDA flow velocity, and left atrial enlargement were significantly associated with aggressive treatment decisions in preterm neonates with PDA. Furthermore, a low base deficit influenced the need for surgery following medical therapy failure. Our findings suggest that comprehensive monitoring of both clinical and echocardiographic factors may support treatment decision-making in PDA management in preterm neonates.

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