Incidence of Surgical or Interventional Closure of Persistent Ductus Arteriosus in Very Low Birth Weight Preterm Infants in Germany

Background: In Germany, 8 to 9% of all newborns are preterm, with 1% of them born at less than 1,500 g as very low birth weight infants (VLBWIs). Spontaneous PDA closure in VLBWIs is delayed and inversely related to gestational age and birth weight. Hemodynamically significant PDA (HSPDA) occurs in 50% of infants with <28 weeks GA. Medical treatment is the first choice despite an up to 40% failure rate. If medical treatment fails, surgical closure (SC) has been the standard therapy until now. Recently, interventional closure (IC) has become available and is increasingly offered to preterm infants suffering from HSPDA. So far, no data concerning the frequency and safety of interventional or surgical HSPDA closure in Germany are available.

Methods: Two years of prospective data from the German ESPED Survey were collected regarding the frequency of SC or IC of HSPDA in VLBWIs.

Results: In total, data of 118 VLBWIs with HSPDA and treatment admitted to German Level-III NICUs, were entered in the ESPED registry (2022–2023). The median gestational age was 25^0/7 weeks (IQR 24^0/7, 26^0/7) with a median birth weight of 680 g (IQR 573, 788), 49% male (n = 58), and 51% female (n = 60). Most infants received at least one kind of medical treatment before mechanical closure (n = 110; 93%). Drugs used for medical treatment were ibuprofen (n = 100; 85%), paracetamol (n = 50; 42%), and indomethacin (n = 30; 25%), and multiple treatments were included. The median age at SC or IC was 30 days (IQR 21, 46) with a median weight of 1,015 g (IQR 870, 1,306). SC was performed in 72 infants (61%) and IC in 46 infants (39%). Overall, 24 (20%) treated infants developed posttreatment complications. Those were observed in 11/72 (15%) infants after SC and 13/46 (28%) after IC. The main complications were vocal cord paresis, pneumothorax and bleeding after SC and renal venous thrombosis, occlusion of the femoral artery, device dislocation, and stenosis of LPA after IC.

Conclusion: In 118 VLBWIs cared for in German NICUs, surgical or interventional PDA closure was performed before discharge. Most infants received medical treatment before closure. Despite the fact that IC is not yet standard and large RCTs are lacking, the method is increasingly used for the treatment of HSPDA in this population. We observed, however, clinically relevant complications with both methods with substantially more complications in infants after IC. Consequently, more well-designed studies are required to define the best treatment for VLBWIs with HSPDA.

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Artikel online veröffentlicht:
11. Februar 2025