Conservative management of PDA in low birth weight neonates doesn't increases mortality: Study

A hemodynamically significant patent ductus arteriosus (PDA) in preterm neonates is considered a risk factor for mortality, and morbidities such as bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and intraventricular hemorrhage (IVH). A causal relationship between PDA and these adverse outcomes; however, has not been established.

Recent observational studies suggest that PDA closes spontaneously in most preterm neonates and use of a conservative approach for its management does not result in an increase in morbidity or mortality. Hence, Manoj Modi and colleagues from the Department of Neonatology, Sir Ganga Ram Hospital, New Delhi, India carried out the present study to compare outcomes of very low birth weight (VLBW) neonates before and after the change in practice for the treatment of PDA.

The authors reviewed the medical records of VLBW neonates. Neonates were categorized into two groups: Period I (January 2012 to July 2015) and Period II (August 2015 to December 2016). The primary outcome of the study was a composite outcome of death or broncho-pulmonary dysplasia (BPD).

The following were the findings-

1. The composite outcome (Death/BPD) was comparable in two groups; adjusted OR (95% CI) 1.1 (0.6, 1.9).
2. Mortality and severe BPD was also comparable.
3. The pharmacological treatment for PDA was required in 8.4% vs 2.6% of VLBW neonates during Period I and II, respectively (P=0.03).
4. Durations of invasive and noninvasive ventilation were comparable during two periods.

Therefore, the authors concluded that "Restrictive threshold for management of PDA in VLBW neonates may not be associated with an increase in morbidities or mortality and possibly would reduce the need for pharmacological treatment or surgical ligation."