Patent ductus arteriosus, tracheal ventilation, and the risk of bronchopulmonary dysplasia

• Published in: Pediatric research Vol. 91; no. 3; pp. 652 - 658
• Main Authors: Clyman, Ronald I., Hills, Nancy K., Cambonie, Gilles, Debillon, Thierry, Ligi, Isabelle, Gascoin, Geraldine, Patkai, Juliana, Beuchee, Alain, Favrais, Geraldine, Durrmeyer, Xavier, Flamant, Cyril, Rozé, Jean Christophe
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01-02-2022; Nature Publishing Group
• Subjects: Bronchopulmonary Dysplasia - etiology; Clinical; Clinical Research Article; Congenital diseases; Coronary vessels; Ductus Arteriosus, Patent - complications; Ductus Arteriosus, Patent - therapy; Gestational Age; Human health and pathology; Humans; Incidence; Infant; Infant, Newborn; Intubation; Life Sciences; Lung diseases; Medicine; Medicine & Public Health; Pediatric Surgery; Pediatrics; Pulmonology and respiratory tract; Santé publique et épidémiologie; Time Factors; Ventilation
• ISSN: 0031-3998; 1530-0447; 1530-0447
• DOI: 10.1038/s41390-021-01475-w

Background
An increased risk for bronchopulmonary dysplasia (BPD) exists when moderate-to-large patent ductus arteriosus shunts (hsPDA) persist beyond 14 days.
Goal
To examine the interaction between prolonged exposures to tracheal ventilation (≥10 days) and hsPDA on the incidence of BPD in infants <28 weeks gestation.
Study Design
Predefined definitions of prolonged ventilation (≥10 days), hsPDA (≥14 days), and BPD (room air challenge test at 36 weeks) were used to analyze deidentified data from the multicenter TRIOCAPI RCT in a secondary analysis of the trial.
Results
Among 307 infants who survived >14 days, 41 died before 36 weeks. Among survivors, 93/266 had BPD. The association between BPD and hsPDA depended on the length of intubation. In multivariable analyses, prolonged hsPDA shunts were associated with increased BPD (odds ratio (OR) (95% confidence interval (CI)) = 3.00 (1.58–5.71)) when infants required intubation for ≥10 days. In contrast, there was no significant association between hsPDA exposure and BPD when infants were intubated <10 days (OR (95% CI) = 1.49 (0.98–2.26)). A similar relationship between prolonged hsPDA and length of intubation was found for BPD/death (
n
 = 307): infants intubated ≥10 days: OR (95% CI) = 2.41 (1.47–3.95)); infants intubated <10 days: OR (95% CI) = 1.37 (0.86–2.19)).
Conclusions
Moderate-to-large PDAs were associated with increased risks of BPD and BPD/death—but only when infants required intubation ≥10 days.
Impact
Infants with a moderate-to-large hsPDA that persist beyond 14 days are only at risk for developing BPD if they also receive prolonged tracheal ventilation for ≥10 days.
Infants who receive less ventilatory support (intubation for <10 days) have the same incidence of BPD whether the ductus closes shortly after birth or whether it persists as a moderate-to-large shunt for several weeks.
Early PDA closure may be unnecessary in infants who require short durations of intubation since the PDA does not seem to alter the incidence of BPD in infants who require intubation for <10 days.