Elsevier

The Journal of Pediatrics

Volume 150, Issue 3, March 2007, Pages 229-234.e1
The Journal of Pediatrics

Original article
Neurosensory Impairment after Surgical Closure of Patent Ductus Arteriosus in Extremely Low Birth Weight Infants: Results from the Trial of Indomethacin Prophylaxis in Preterms

https://doi.org/10.1016/j.jpeds.2006.11.039Get rights and content

Objectives

To determine whether surgical closure of a patent ductus arteriosus (PDA) is a risk factor for bronchopulmonary dysplasia (BPD), severe retinopathy of prematurity (ROP), and neurosensory impairment in extremely low birth weight (ELBW) infants.

Study design

We studied 426 infants with a symptomatic PDA, 110 of whom underwent PDA ligation and 316 of whom received medical therapy only. All infants participated in the multicenter Trial of Indomethacin Prophylaxis in Preterms (TIPP) and were observed to a corrected age of 18 months.

Results

Of the 95 infants who survived after PDA ligation, 50 (53%) had neurosensory impairment, compared with 84 of the 245 infants (34%) who survived after receiving only medical therapy (adjusted odds ratio, 1.98; 95% CI, 1.18-3.30; P = .0093). BPD (adjusted odds ratio, 1.81; 95% CI, 1.09-3.03; P = .023) and severe ROP (adjusted odds ratio, 2.20; 95% CI, 1.19-4.07; P = .012) were also more common after surgical PDA closure.

Conclusions

PDA ligation may be associated with increased risks of BPD, severe ROP, and neurosensory impairment in ELBW infants.

Section snippets

Patients

Infants with birth weights between 500 and 999 g were enrolled in the TIPP study between January 1996 and March 1998.3 The research ethics boards of all clinical centers in Canada, the United States, Australia, New Zealand, and Hong Kong approved the trial protocol, and written informed consent was obtained from a parent or guardian of each infant. Participating neonatal intensive care units were located either in tertiary care maternity hospitals or in tertiary care children’s hospitals.

Study Cohort and Status at First Diagnosis of PDA

Of the 1202 infants who were enrolled in the TIPP study, 9 infants died on their calendar day of birth. Adequate data for analysis of the composite outcome at 18 months were available for 1134 of the remaining 1193 infants (95%). There were 708 infants (62%) without a symptomatic PDA, 316 infants (28%) with PDA who were treated without surgery, and 110 infants (10%) who underwent PDA ligation. Table I shows the baseline characteristics of the infants and their mothers for the 2 subgroups of

Discussion

In this large international cohort of ELBW infants, surgical closure of a PDA was a strong risk factor for neurosensory impairment at 18 months. Compared with infants whose PDA was treated without surgery, infants who underwent PDA ligation also had increased risks of BPD and of severe ROP. Deaths appeared to be less common in infants who underwent PDA ligation than in infants in the comparison group. This may represent a true beneficial effect of surgical PDA closure on survival, in keeping

References (24)

  • B. Schmidt et al.

    Impact of BPD, brain injury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months: results from the Trial of Indomethacin Prophylaxis in Preterms

    JAMA

    (2003)
  • A.T. Shennan et al.

    Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period

    Pediatrics

    (1988)
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    Supported by the Medical Research Council of Canada MT-13288. US centers were supported in part by grants from the National Institute of Child Health and Human Development (D U10 HD21364, U10 HD27851, U10 HD21373, U10 HD27881; M01 RR 00997, U10 HD27880; M01 RR 00070, U10 HD21385, U10 HD27904, U10 HD34216). INDOCID P.D.A. was donated by Merck Frosst.

    Other members of the study group are listed in the Appendix available at www.jpeds.com.

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