Elsevier

The Journal of Pediatrics

Volume 203, December 2018, Pages 170-176.e1
The Journal of Pediatrics

Original Articles
Long-Term Neurodevelopment of Low-Birthweight, Preterm Infants with Patent Ductus Arteriosus

https://doi.org/10.1016/j.jpeds.2018.08.004Get rights and content

Objective

To evaluate whether the presence of patent ductus arteriosus (PDA) in preterm infants worsens long-term neurodevelopmental outcomes.

Study design

This was a secondary observational analysis of data from 1090 preterm low-birthweight infants in the Infant Health and Development Program (IHDP), a multicenter longitudinal cohort study of outcomes assessed from 3 to 18 years of age. Multivariable analysis was adjusted for IHDP treatment group (intervention or follow-up), birth weight, maternal race, maternal education, infant sex, maternal preconception weight, Home Observation Measurement of the Environment (HOME) total score at 12 months, neonatal health index, and gestational age.

Results

Of the 1090 patients (49% male) included in the analysis, 135 had a PDA. Mean birth weight (1322 g vs 1871 g; P < .0001) and gestational age (30.2 weeks vs 33.4 weeks, P < .0001) were lower and mean ventilator days (11.8 vs 1.3; P < .0001), vasopressor use (12.6% vs 1.2%; P < .0001), and congestive heart failure (8.9% vs 0.1%; P < .0001) were higher in the PDA group. There were no differences between the PDA and no-PDA groups in maternal education level and HOME total score at age 12 months. Multivariable analysis demonstrated no between-group differences in cognitive development or behavioral competence at age 3, 8, and 18 years.

Conclusions

The presence of a PDA in moderately preterm, low-birthweight infants does not impact long-term neurodevelopmental outcomes.

Section snippets

Methods

This study was a secondary analysis of prospectively collected data from the Infant Health and Development Program (IHDP), resulting in a longitudinal cohort with follow-up from birth to age 18 years. The IHDP was a collaborative, multicenter randomized controlled longitudinal intervention study initiated in 1985. The study evaluated the efficacy of center-based early educational intervention, home-based family support services, and pediatric follow-up on long-term mental and physical health in

Results

A total of 1090 infants (49% male) enrolled in the IHDP study met the inclusion criteria for the present analysis, of whom 135 (54% male) had a PDA. Table I reports the distributions of IHDP prerandomization variables between those with a PDA (PDA group) and those without a PDA (no-PDA group). Subjects with a PDA had lower mean birth weight (1322 ± 433 g vs 1871 ± 418 g; P < .0001) and mean gestational age (30.2 ± 2.6 weeks vs 33.4 ± 2.4 weeks; P < .0001) and had more complex neonatal courses,

Discussion

In this study using rigorous cognitive assessments through age 18 years, we found no difference in neurodevelopmental outcomes between the PDA and no-PDA groups. Few reports have provided follow-up data to young adulthood in patients with PDA or any other form of congenital heart disease.40 Given the rigorous, multicenter design of our study and long duration of follow-up, it is unlikely that a similar study will be undertaken, and even if it were, the results would still be at least 2 decades

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    The authors declare no conflicts of interest.

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