0907 1½ to 2 year outcome after patent ductus (PDA) in infants below 1000 gm at birth

One cannot be anything other than impressed by the names of institutions that submitted data to the NICHD’s NRN GDB (Neonatal Research Network Generic Data Base) covering infants of 23-28 weeks gestation born between 1 January 2000 and December 2004 with birthweight between 401 – 1000gm. Equally impressive is the group that utilised the data to interrogate the 18-22 month outcome for 2838 infants who were diagnosed with a PDA and survived for the full follow-up period. This group was derived from a larger group of 6333 gestationally and weight-eligible infants of which 2507 did not have a PDA and 983 were lost to follow-up or were missing data. Subjects fell into one of 4 groups: no treatment i.e. supportive care only (n=403), indomethacin only (n=1525), indomethacin plus surgery (n=775) and primary surgery (n=135). Approximately 30% of the first three groups also received prophylactic indomethacin, while only 13% of the primary surgery group received prophylactic indomethacin. Outcome measures were death or neurodevelopmental impairment (NDI: cerebral palsy, no useful vision in either eye, hearing aids in each ear, or a score of <70 on either the Bayley MDI or PDI), as well as incidence of BPD and NEC. Infants undergoing surgery were ±30 gm lighter and a few days younger (by gestational age) than those treated conservatively or with indomethacin alone. Around 50% of all groups received >1 dose of surfactant. Overall morbidity rates were fairly high with NDI and BPD occurring more frequently in infants who required surgery (odds ratio for NDI 1.53 to 1.79; and for BPD 2-3-fold higher than those receiving indomethacin alone). NEC rates were similar in surgery and non-surgery groups, and there were no differences between the infants who received only supportive care vs those who received indomethacin alone. The authors question whether the outcomes were primarily attributable to the PDA intervention/s, the failure of therapy, the inherent risks of surgery or the underlying risks of PDA, and readers are once again presented with results of a large retrospective study that while seeking answers mainly comes up with more questions.

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Pediatrics 2009; 123: 674-81
Cochrane Database Syst Rev 2008, Jan 23; (1): CD003481
J Pediatr 2007, 150: 216-9