P1.167: Respiratory Outcomes in Extremely Low Birth Weight Neonates Receiving Transcatheter Patent Ductus Arteriosus Closure Versus Conservative Management

Background: Management of patent ductus arteriosus (PDA) continues to remain a widely debated topic. In recent years, transcatheter PDA closure (TCPC) has been increasingly used in preterm for PDA management. Studies have shown benefit and safety of TCPC over surgical ligation, but limited knowledge is available for patient selection for TCPC and its short-term benefits compared to conservative management. We postulated a cohort of preterm neonates who have echocardiogram (ECHO) confirmed PDA and requiring intubation beyond 2 weeks of age may benefit from PDA closure.

Methods: We conducted this review with the hypothesis that in neonates born < 29 weeks gestational age (GA), requiring intubation at 2 weeks of age, and with presence of moderate/large PDA, TCPC will have improved BPD and mortality compared to conservative management (CM). Retrospective chart review from Jan 2020 to Feb 2024 of neonates born < 29 weeks GA that required intubation at 2 weeks and with ECHO confirmed moderate/large PDA was performed. Neonates with major congenital heart disease, pulmonary malformation, genetic defects, or transferred prior to discharge were excluded. Primary outcomes were Death or Bronchopulmonary dysplasia (BPD-Jensen’s 2019) and Death or moderate-severe BPD. Analysis was performed using Chi-square, and independent t-tests. All p-values were two-sided. Multivariate logistic and linear regression model was used for adjusting for confounders.

Results: Of neonates that fulfilled inclusion criteria, 36 were in CM group and 62 were in TCPC group. Baseline characteristics were similar except for small for gestational age (SGA) (CM=19.4%, TCPC=50%, p=0.003), post-natal steroid exposure (CM=13.9%, TCPC=59.7%, p= < 0.001), and surgical NEC (CM=25%, TCPC=6.5%, p=0.013) (Table 1). Average age of TCPC was 61 days with SD= 26.2. There was no difference in primary outcomes. CM group had higher No BPD rates, lower Grade 3 BPD, and ventilation days compared to TCPC group (Table 2). More neonates went home on respiratory/PH medications and g-tubes in the TCPC group. When adjusting for confounders, p values remained significant for BPD grade 3, home medication, G-tube, mechanical ventilation duration and length of stay (Table 2).

Conclusion: In neonates born < 29 weeks GA requiring intubation longer than 2 weeks and ECHO confirmed PDA, TCPC failed to show benefits in short term outcomes when compared to CM. Rates of grade 3 BPD, duration of ventilation, need for home medications, and G-tube placement were higher in the TCPC group. But this data should be interpreted with caution owing to possible confounders and wide confidence interval in adjusted analysis. Timing of TCPC in our study may have played a role in the findings, but our results highlights need for further studies focusing on patient selection and indications for TCPC.