234 Surgical Closure of A Patient Ductus Arteriosus (PDA) is Associated with Increased Neuro-Sensory Impairment in Extremely Low Birth Weight (ELBW) Infants: Results from The Trial of Indomethacin Prophylaxis in Preterms

Abstract

Background: The Victorian Infant Collaborative Study Group has reported that surgery with general anesthesia during the initial hospitalization increases the risk of adverse sensorineural outcome in ELBW infants. PDA ligation was the single most frequent type of surgery in this study. Objective: To determine whether surgical PDA closure was a risk factor for neurosensory impairment in ELBW infants who participated in the international Trial of Indomethacin Prophylaxis in Preterms (TIPP). Methods: Using the TIPP database, we studied 1180 children who survived their first day of birth. Infants were divided into 3 groups according to their PDA status in the NICU: ‘No PDA', ‘Non-surgical PDA', and ‘Surgical PDA'. As in TIPP, the primary outcome was a composite of death or neurosensory impairment at a corrected age of 18 months (cerebral palsy, cognitive delay, deafness, and blindness). Deaths and impairments were also examined separately. Odds ratios and 95% confidence intervals were calculated to estimate the differences in prognostic risk for the ‘No PDA' and the ‘Surgical PDA' groups in comparison with the ‘Non-surgical PDA' group. The analysis was adjusted for gestational age, gender, multiple birth, antenatal steroids, mother's education, and moderate to severe pulmonary hemorrhage. We also examined the relationship between the rate of surgical PDA closure in individual study centres and the 18-month outcome. Results: The results are summarized in the table. There was a significant direct correlation between the rates of surgical PDA closure in individual study centres and the prevalence of neurosensory impairments in survivors (p=0.032). Conclusion: Surgical PDA closure was associated with reduced mortality but increased neurosensory impairment in ELBW infants. It remains uncertain whether PDA ligation is a cause or a marker of adverse long-term outcome in this population.