Incidence, Characteristics, Management and Outcomes of neonates with Patent Ductus Arteriosus (PDA) at Chris Hani Baragwanath Academic Hospital

Abstract

Incidence, Characteristics, Management and Outcomes of Very Low Birth Weight Infants with Patent Ductus Arteriosus (PDA) at Chris Hani Baragwanath Academic Hospital Naidoo D1, Nakwa, F.L.1, Thandrayen, K, Thomas R1. 1Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand Introduction: Patent Ductus Arteriosus (PDA) accounts for 5-10% of congenital heart disease and is found in 300 per 1000 preterm infants. Significant morbidity and mortality have been associated with PDA. There is limited data available on PDA in low to middle income countries. Methods: This was a retrospective study carried out at Chris Hani Baragwanath Academic Hospital (CHBAH) between January to December 2017. Data on very low birth weight (VLBW) infants were extracted from the neonatal and paediatric cardiology unit’s electronic databases and clinical records of patients with a diagnosis of PDA on echocardiography were retrieved for analysis. Results Of the 859 VLBW infants admitted during the study period, 54(6.2%) had a diagnosis of PDA on echocardiography. PDA was more common in low birthweight (p=0.001) and lower gestational age (p=0.005) infants. Forty (74%) presented with an ejection systolic murmur and 29 (54%) were deemed haemodynamically significant (>1.4mm). Thirty-one infants (57%) were managed with watchful waiting. There were 21(39%) patients managed medically of these, eighteen( 86%) patients were managed using Ibuprofen ( 86%) making it the most common agent used among infants who were managed medically. Infants with a PDA had higher rates of intraventricular haemorrhage (IVH) [37% vs 12.4%; p-0.001], bronchopulmonary dysplasia (BPD) [42.6% vs 11.8%; p-0.001] and had a longer hospital stay (p=0.001). Risk factors for mortality were lower gestational age (OR 0.65, p<0.001, 0.6-0.71) and IVH (OR1.44, p<0.001, CI 1.17-2.18). iv Conclusion PDA is inversely proportional to gestational age and birth weight. Comorbidities in infants with PDA increased the hospital stay. Early identification and appropriate management are important as it may impact on these co-morbidities and length of hospital stay.