Department of Pediatrics, Robert Larner, MD, College of Medicine, University of Vermont, Burlington, Vermont.
Vermont Oxford Network, Burlington, Vermont.
Pediatrics. 2024 Aug 1;154(2). doi: 10.1542/peds.2024-065905.
The optimal patent ductus arteriosus (PDA) closure method in very low birth weight (VLBW) infants is uncertain. In 2019, the first transcatheter occlusion device was approved in the United States for infants ≥700 g. We described survival and short-term outcomes among VLBW infants who underwent transcatheter or surgical PDA closure (2018-2022).
Vermont Oxford Network members submitted data on infants born from 401 to 1500 g or 22 to 29 weeks' gestational age. Adjusted risk ratios (aRR) for survival, length of stay (LOS), prematurity complications, and discharge support were used to compare transcatheter versus surgical closure. Subgroup analyses were conducted for infants with birth weight ≥700 g and born in 2020-2022.
Overall, 6410 of 216 267 infants at 726 hospitals received invasive PDA treatment. Transcatheter closure increased from 29.8% in 2018 to 71.7% in 2022. VLBW infants undergoing transcatheter closure had higher survival (adjusted rate ratio [aRR] 1.03; 1.02-1.04) with similar LOS (aRR 1.00; 0.97-1.03), neonatal complications (aRR 1.00; 0.98-1.01), and receipt of discharge support (aRR 0.94; 0.89-1.01). In subgroup analyses, survival (aRR 1.02; 1.00-1.04) and discharge support (aRR 0.90; 0.81-1.01) were similar between groups, whereas selected neonatal complications (aRR 0.95; 0.93-0.98) and LOS (aRR 0.95; 0.90-0.99) were lower after transcatheter closure.
Transcatheter PDA closure in VLBW infants was increasingly used after 2018. Selected short-term outcomes for infants receiving transcatheter closure may be more favorable, compared with surgical, and warrants further clinical investigation.
极低出生体重儿（VLBW）最佳动脉导管未闭（PDA）闭合方法尚不确定。2019 年，首款经导管封堵器在美国获批用于≥700g 婴儿。我们描述了 2018-2022 年间接受经导管或手术 PDA 闭合治疗的 VLBW 婴儿的生存和短期结局。
Vermont Oxford Network 成员提交了胎龄 22-29 周、出生体重 401-1500g 的婴儿数据。采用校正风险比（aRR）比较经导管与手术闭合的生存率、住院时间（LOS）、早产儿并发症和出院支持。对出生体重≥700g 且出生于 2020-2022 年的婴儿进行亚组分析。
总体而言，216267 例 726 家医院的婴儿中，有 6410 例接受了侵入性 PDA 治疗。经导管闭合的比例从 2018 年的 29.8%增加到 2022 年的 71.7%。行经导管闭合的 VLBW 婴儿生存率更高（校正率比[aRR] 1.03；1.02-1.04），住院时间相似（aRR 1.00；0.97-1.03），新生儿并发症（aRR 1.00；0.98-1.01）和获得出院支持（aRR 0.94；0.89-1.01）。在亚组分析中，两组间生存率（aRR 1.02；1.00-1.04）和出院支持率（aRR 0.90；0.81-1.01）相似，而选择性新生儿并发症（aRR 0.95；0.93-0.98）和住院时间（aRR 0.95；0.90-0.99）较低。
2018 年后，经导管 PDA 闭合在 VLBW 婴儿中越来越多地使用。与手术相比，接受经导管闭合治疗的婴儿的某些短期结局可能更有利，值得进一步临床研究。
