(4) Neonates with a Hemodynamically Significant PDA in the First Two Weeks of Life Can Be Distinguished from Those Without by Blood Pressure and Echocardiographic Markers of Volume Loading

Amy Hobson, Univeristy of Iowa, Riverside, IL, United States; Regan E. Giesinger, University of Iowa, Iowa City, IA, United States; Adrianne Rahde Bischoff, University of Iowa, United States; Amy H Stanford, University of Iowa Stead Family Children's Hospital, United States; Patrick J. Mcnamara, University of Iowa, United States; Danielle R Rios, University of Iowa Stead Family Children's Hospital, United States

Background: Premature infants have multiple risk factors that favor ductal patency which supports the high incidence of a patent ductus arteriosus (PDA). Currently, there is wide variation in screening, management strategies, and treatment regimens for the preterm PDA, with little attention in the first two weeks of life. However, it has been demonstrated that premature infants are at increased risk of complications which can be further worsened by a hemodynamically significant PDA (hsPDA).

Objectives: To compare variables in neonates with a hsPDA for the majority of time during the first two weeks of life to neonates with minimal to no exposure from a hsPDA.

Design/Methods: A retrospective review was conducted in neonates born less than 27 weeks gestational age between March 2020 to November 2021 who were admitted to the neonatal intensive care unit. We analyzed two groups of patients: those with hsPDA for >65% (9-14 days) or < 35% (0-5 days) of the time in the first two weeks. We compared demographic, clinical, and targeted neonatal echocardiographic (TnECHO) markers between the two groups.

Results: 106 patients were eligible for this study of which 24 and 56 had a hsPDA for >65% or < 35% of the first two weeks, respectively and were included in analysis. Mean gestational age and birth weight were 24.7 ± 1.5 weeks and 683 ± 199 grams, respectively. Patients with hsPDA for >65% of the first two weeks had statistically significant changes in TnECHO markers of volume loading (p < 0.001) and lower blood pressure (p < 0.001). They also were more likely to require medical (p < 0.001) or interventional (p < 0.001) closure of the PDA.

Conclusion: Identification of premature infants in the first two weeks of life with high risk of continued hsPDA exposure is possible and earlier identification should be considered along with echocardiogram guidance which may lead to reduction of complications associated with hsPDA.