Morbidity and mortality in preterm neonates with patent ductus arteriosus on day 3

OBJECTIVE: To assess the association between a patent ductus arteriosus (PDA) on day 3 of life and severe morbidity and mortality.

DESIGN: Cohort study.

SETTING: Neonatal Intensive Care Unit, Aarhus University Hospital, Denmark.

PATIENTS: All neonates with a gestational age less than 32 weeks admitted from 2010 to 2012.

INTERVENTIONS: All neonates (n=183) were routinely screened with echocardiography for PDA on day 3 of life. Information on baseline characteristics and outcome was collected by structured coding sheets and medical records.

MAIN OUTCOME MEASURES: The association among PDA diameter and pulmonary haemorrhage, intraventricular haemorrhage (IVH), necrotising enterocolitis, bronchopulmonary dysplasia (BPD), death, and the composite outcome of death or severe morbidity was assessed.

RESULTS: In neonates, born prior to 28 gestational weeks, a PDA on day 3 of life was associated with a threefold increase in odds of death or severe morbidity compared with neonates without PDA (OR=3.4; CI 1.1 to 11). The odds were highest in neonates with a large PDA (diameter ≥1.5 mm). Neonates with a large PDA were also found to have increased odds of IVH (OR 4.2; CI 1.3 to 14) and BPD (OR 3.7; CI 1.0 to 14) compared with neonates with no PDA.

CONCLUSIONS: In neonates born with a gestational age below 28 weeks the presence of a PDA on day 3 of life was associated with adverse outcome; this association was even more pronounced with a large PDA. Thus, early echocardiography may facilitate the identification of neonates suitable for a targeted approach to intervention in future randomised controlled trials.