Can Early Diagnosis - Treatment of A Hemodynamically Significant Patent Ductus Arteriosus Reduce the Incidence of Pulmonary Hemorrhage in Extreme Low Birth Weight Infants?

Abstract

Objective: To identify pulmonary hemorrhage incidence modification after early diagnosis-treatment of an hsPDA in ELBW infants. Study design: Data from extreme preterm infants treated by Ibuprofen were retrospectively and prospectively reviewed. X2 test and Fisher’s exact test were used for categorical analyses. t-test and Kruskl-Wallis test were used for continuous analyses. Multivariate analyses with logistic regression models were used to control for differences in observed covariates. Results: Fifty-five ELBW infants were diagnosed with PDA. Significant increase in survival in early ibuprofen group (67.7% vs 91.5%; p = .033) was seen; with a significant reduction in the pulmonary hemorrhage incidence in the 26 – 276/7 WGA in EIG (22.7% vs 0%; p = .047). To note that, proven – NEC cases occurred more frequently in the 24 – 256/7 WGA in EIG with a significant difference (44.4% vs 0%; p = .041). Conclusion: Early treatment of hemodynamically significant patent ductus arteriosus is associated with an increase in survival in ELBW infants with less pulmonary hemorrhage, especially in the 26 – 276/7 WGA. In another hand, developing proven-NEC increased if 24 – 256/7 WGA were treated earlier by Ibuprofen for their PDA. Future prospective, multi-centric, large-scale randomized trials should be conducted to determine the best strategies for PDA management, especially in ELBW infants.