Trends in Procedural Closure of the Patent Ductus Arteriosus among Infants Born at 22 to 30 Weeks' Gestation

Zubin S Shah; Reese H Clark; Hanoch A Patt; Carl H Backes Jr; Veeral N Tolia

doi:10.1016/j.jpeds.2023.113716

Trends in Procedural Closure of the Patent Ductus Arteriosus among Infants Born at 22 to 30 Weeks' Gestation

J Pediatr. 2023 Dec:263:113716. doi: 10.1016/j.jpeds.2023.113716. Epub 2023 Aug 31.

Authors

Zubin S Shah¹, Reese H Clark², Hanoch A Patt³, Carl H Backes Jr⁴, Veeral N Tolia⁵

Affiliations

¹ Department of Pediatrics, Baylor University Medical Center, Dallas, TX; Department of Pediatrics, Texas A&M School of Medicine, Dallas, TX.
² The Pediatrix Center for Research, Education, Quality, and Safety, Sunrise, FL.
³ Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX; Department of Pediatrics, University of Texas at Austin Dell Medical School, Austin, TX.
⁴ Divisions of Neonatology and Cardiology, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.
⁵ Department of Pediatrics, Baylor University Medical Center, Dallas, TX; The Pediatrix Center for Research, Education, Quality, and Safety, Sunrise, FL. Electronic address: Veeral.tolia@pediatrix.com.

PMID: 37659585
DOI: 10.1016/j.jpeds.2023.113716

Abstract

Objective: To describe recent trend in procedural closure of the patent ductus arteriosus (PDA) among premature infants and compare the clinical characteristics of infants receiving surgical vs transcatheter closure.

Study design: We conducted a descriptive, retrospective cohort study of preterm infants born between 22^0/7 and 29^6/7 weeks' gestation from 2014 through 2021. Infants were identified from the Pediatrix Clinical Data Warehouse. We excluded infants with any major congenital anomaly. We identified all preterm infants with a PDA and all those who underwent procedural closure (surgical ligation or transcatheter occlusion) and compared changes over time using ANOVA for continuous variables and the Cochran-Armitage trend test to evaluate time-related changes in proportions.

Results: The study cohort included 64 580 infants, of whom 24 028 (37.2%) were diagnosed with a PDA. The number of infants receiving any procedural closure of the PDA decreased from 371 (4.4%) in 2014 to 144 (1.9%) in 2021. During the same period, number of surgical ligations decreased from 369 (4.36%) to 64 (0.84%), and the number of transcatheter occlusions increased from 2 (0.02%) to 80 (1.05% p for all < 0.001). The median age at time of surgical ligation increased from 25 days (10th and 90th percentile, 10, 61) to 31 days (10th and 90th percentile, 16, 66), and the median age of transcatheter occlusion decreased from 103 days (10th and 90th percentile, 32, 150) to 43 days (10th and 90th percentile, 22, 91).

Conclusions: There was a decrease in surgical closure and an increase in transcatheter occlusion of the PDA in infants born at 22-30 weeks' gestation from 2014 to 2021. Despite the decline in overall procedural closure, the rate of transcatheter occlusion surpassed surgical ligation by 2021. Narrowing differences in the median age and weight at closure suggest increasing overlap in the types of infants who received each type of procedural closure.

Keywords: patent ductus arteriosus; premature infants.

MeSH terms

Ductus Arteriosus, Patent* / diagnosis
Ductus Arteriosus, Patent* / surgery
Female
Gestational Age
Humans
Infant
Infant, Newborn
Infant, Premature
Ligation
Pregnancy
Retrospective Studies
Treatment Outcome
Vascular Diseases*