Changes in PDA Treatment Strategy and Respiratory Outcomes in Premature Infants

Objective To evaluate whether change in PDA management strategies over time had an impact on respiratory outcomes in premature infants. Study design Prospectively collected data were included from all preterm infants born at 23-30 weeks gestational age (GA) with PDA admitted to UM/JMH from January 1, 2005 to December 31, 2007 (Epoch 1) and January 1, 2011 to December 31, 2015 (Epoch 2). The 2 epochs were compared for approach to PDA diagnosis and subsequent management strategies and respiratory outcomes. Results Significantly fewer infants were treated for PDA in Epoch 2 (54%) compared with Epoch 1 (90%). Multivariable logistic regression analysis demonstrated that infants in Epoch 2, with later PDA diagnosis and less frequent PDA treatment, had greater odds of BPD, composite of BPD or death, and more treatment with postnatal steroids than in Epoch 1. Conclusion The change in approach to diagnosis and management of PDA, from a more proactive and aggressive approach during the earlier Epoch 1 to a more expectant approach during the subsequent Epoch 2, was associated with worse respiratory outcomes, including increase in BPD and in BPD or death.