Patent ductus arteriosus, tracheal ventilation, and the risk of bronchopulmonary dysplasia

Ronald I Clyman,Geraldine Favrais,Isabelle Ligi,Jean Christophe Rozé,Thierry Debillon,Gilles Cambonie,Nancy K Hills,Xavier Durrmeyer,Alain Beuchee,Juliana Patkai,Geraldine Gascoin,Cyril Flamant

doi:10.1038/s41390-021-01475-w

Abstract

BackgroundAn increased risk for bronchopulmonary dysplasia (BPD) exists when moderate-to-large patent ductus arteriosus shunts (hsPDA) persist beyond 14 days.GoalTo examine the interaction between prolonged exposures to tracheal ventilation (≥10 days) and hsPDA on the incidence of BPD in infants <28 weeks gestation.Study DesignPredefined definitions of prolonged ventilation (≥10 days), hsPDA (≥14 days), and BPD (room air challenge test at 36 weeks) were used to analyze deidentified data from the multicenter TRIOCAPI RCT in a secondary analysis of the trial.ResultsAmong 307 infants who survived >14 days, 41 died before 36 weeks. Among survivors, 93/266 had BPD. The association between BPD and hsPDA depended on the length of intubation. In multivariable analyses, prolonged hsPDA shunts were associated with increased BPD (odds ratio (OR) (95% confidence interval (CI)) = 3.00 (1.58–5.71)) when infants required intubation for ≥10 days. In contrast, there was no significant association between hsPDA exposure and BPD when infants were intubated <10 days (OR (95% CI) = 1.49 (0.98–2.26)). A similar relationship between prolonged hsPDA and length of intubation was found for BPD/death (n = 307): infants intubated ≥10 days: OR (95% CI) = 2.41 (1.47–3.95)); infants intubated <10 days: OR (95% CI) = 1.37 (0.86–2.19)).ConclusionsModerate-to-large PDAs were associated with increased risks of BPD and BPD/death—but only when infants required intubation ≥10 days.ImpactInfants with a moderate-to-large hsPDA that persist beyond 14 days are only at risk for developing BPD if they also receive prolonged tracheal ventilation for ≥10 days.Infants who receive less ventilatory support (intubation for <10 days) have the same incidence of BPD whether the ductus closes shortly after birth or whether it persists as a moderate-to-large shunt for several weeks.Early PDA closure may be unnecessary in infants who require short durations of intubation since the PDA does not seem to alter the incidence of BPD in infants who require intubation for <10 days.

Highlights

INTRODUCTION Between50 and 70% of infants
The left-to-right PDA shunt increases the risk of several neonatal morbidities that occur during the first week after birth, and early PDA closure can decrease the incidence of these morbidities.[2,3,4,5,6]
When the human clinical trials were initially designed there was little information available to determine which infants with a PDA were at risk for developing bronchopulmonary dysplasia (BPD)

Summary

Introduction

Whether exposure to a PDA shunt increases the risks of later neonatal morbidities, like bronchopulmonary dysplasia (BPD), is still unclear. An increased risk for bronchopulmonary dysplasia (BPD) exists when moderate-to-large patent ductus arteriosus shunts (hsPDA) persist beyond 14 days. GOAL: To examine the interaction between prolonged exposures to tracheal ventilation (≥10 days) and hsPDA on the incidence of BPD in infants

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Methods

Conclusion