Chock Valerie Y, Bhombal Shazia, Davis Alexis S, Sankar Meera N, Do Barbara T, Laughon Matthew M, Van Meurs Krisa P, Backes Carl H, McNamara Patrick J
Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California.
Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
JAMA Netw Open. 2025 Jun 2;8(6):e2513366. doi: 10.1001/jamanetworkopen.2025.13366.
Transcatheter closure of the patent ductus arteriosus (PDA) has increasingly been adopted in extremely preterm infants as a method to definitively close the PDA while avoiding the inherent risks of surgical ligation. Differences in respiratory outcomes after transcatheter closure compared with surgical ligation have not been substantiated, particularly in the context of timing of the intervention.
To characterize respiratory outcomes in extremely preterm infants with PDA treated with transcatheter device closure compared with surgical ligation.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study assessed data from preterm infants born at less than 29 weeks' gestation or with birth weight less than 1000 g who underwent definitive PDA closure in neonatal intensive care units participating in the Neonatal Research Network's Generic Database between January 1, 2016, and December 31, 2020. Data were analyzed from October 2021 to February 2024.
PDA treatment with transcatheter device closure or with surgical ligation.
The primary outcome was total days of mechanical ventilation.
Of 3806 included infants with a PDA diagnosis, 202 underwent transcatheter PDA closure (median [IQR] gestational age, 25.4 [24.1-27.1] weeks; 114 [56%] female) and 359 underwent surgical ligation (median [IQR] gestational age, 24.9 [24.0-25.9] weeks; 187 [52%] female). Infant age at transcatheter closure was older than at surgical ligation (mean [SD], 58.7 [28.4] vs 33.6 [16.7] days; P < .001). After adjustment of analyses for center, birth year, gestational age, age at PDA intervention, and prior pharmacologic treatment, infants with transcatheter closure compared with surgical ligation had comparable respiratory outcomes, including total days of mechanical ventilation (adjusted median difference, -2.65 [95% CI, -8.36 to 3.07] days; P = .36).
In this cohort study of extremely preterm infants who underwent transcatheter closure compared with surgical ligation for treatment of PDA, respiratory outcomes did not differ, although the transcatheter closure group had a longer duration of PDA exposure. Future research evaluating outcomes after transcatheter PDA closure should assess the optimal timing of definitive intervention.
经导管关闭动脉导管未闭（PDA）在极早产儿中越来越多地被采用，作为一种明确关闭PDA的方法，同时避免手术结扎的固有风险。与手术结扎相比，经导管关闭术后呼吸结局的差异尚未得到证实，尤其是在干预时机方面。
比较经导管装置关闭与手术结扎治疗极早产儿PDA后的呼吸结局。
设计、设置和参与者：这项回顾性队列研究评估了2016年1月1日至2020年12月31日期间在参与新生儿研究网络通用数据库的新生儿重症监护病房接受PDA明确关闭的孕周小于29周或出生体重小于1000克的早产儿的数据。数据于2021年10月至2024年2月进行分析。
经导管装置关闭或手术结扎治疗PDA。
主要结局是机械通气总天数。
在3806例纳入的PDA诊断婴儿中，202例接受了经导管PDA关闭（中位[IQR]孕周，25.4[24.1 - 27.1]周；114例[56%]为女性），359例接受了手术结扎（中位[IQR]孕周，24.9[24.0 - 25.9]周；187例[52%]为女性）。经导管关闭时的婴儿年龄大于手术结扎时（平均[SD]，58.7[28.4]天对33.6[16.7]天；P <.001）。在对中心、出生年份、孕周、PDA干预时的年龄和先前的药物治疗进行分析调整后，与手术结扎相比，经导管关闭的婴儿具有可比的呼吸结局，包括机械通气总天数（调整后的中位差异，-2.65[95%CI，-8.36至3.07]天；P = 0.36）。
在这项对接受经导管关闭与手术结扎治疗PDA的极早产儿的队列研究中，呼吸结局没有差异，尽管经导管关闭组的PDA暴露时间更长。未来评估经导管PDA关闭术后结局的研究应评估明确干预的最佳时机。
