Effect of Treatment of Patent Ductus Arteriosus on Pulmonary Hemorrhage in Very Low Birth Weight Neonates

Abstract

Background: Pulmonary hemorrhage (PH) is a serious health concern in very low birth weight (VLBW) infants and is often associated with patent ductus arteriosus (PDA). Objectives: This study explored the role of PDA treatment in VLBW infants weighing less than 1500 g who demonstrated signs of PDA on their initial echocardiography. Methods: This retrospective cohort study was conducted between March 2018 and March 2022 at a teaching hospital in Tehran, Iran. It included neonates with birth weights under 1500 g who were identified with PDA on their first echocardiography. The infants were divided into two groups based on the hemodynamic significance of PDA (hs-PDA). The persistence of ductus arteriosus (DA) and the extent of PH in pharmacologically treated and untreated neonates were then analyzed. Results: Of 127 VLBW infants, 45 were found to have PDA on their first echocardiography, with 16 exhibiting hs-PDA. Statistical analysis using Fisher's exact test revealed no significant difference in PDA closure rates between the treated and untreated groups (P = 0.43). Residual PDA was significantly associated with PH (P = 0.04), whereas the presence of hs-PDA alone did not predict PH (P = 0.24). Despite pharmacological treatment for hs-PDA, there was no significant increase in ductal closure rates, although residual PDA was associated with an increased risk of PH. Conclusions: This study provides valuable insights into the relationship between PDA treatment and PH in VLBW infants. The findings challenge the practice of treating PDA solely based on echocardiographic criteria, as pharmacological treatment did not significantly prevent PH or improve PDA closure rates. Additional criteria beyond echocardiographic findings are necessary for making informed decisions regarding PDA treatment to minimize the risk of PH in VLBW newborns.