Perinatal risk factors for hemodynamically significant patent ductus arteriosus in very low birth weight infants

BACKGROUND: Multiple perinatal factors influence hemodynamically significant patent ductus arteriosus (HS PDA) in preterm infants. PURPOSE: This study aimed to identify the risk factors associated with HS PDA in very low birth weight infants (VLBWIs) and determine the predictors of surgical ligation. METHODS: This retrospective study included VLBWIs born at 23-32 weeks' gestation whose HS PDA properties could be identified using echocardiography. The infants were stratified into 2 groups based on gestational age (23-27 and 28-32 weeks). RESULTS: Among the 496 included VLBWIs, 171 had no PDA, 90 had non-HS PDA, and 235 had HS PDA. In infants born at 23-27 weeks' gestation, risk factors for HS PDA included low birth weight, the absence of histological chorioamnionitis, and premature rupture of membranes. For VLBWIs born at 28-32 weeks' gestation, HS PDA was associated with lower birth weight, frequent surfactant treatment, and maternal hypertension. Within the HS PDA group, infants with a lower birth weight or who received incomplete antenatal steroid administration had an increased likelihood of requiring surgical ligation, whereas those with a small-for-gestational-age status had a decreased need for surgical ligation. CONCLUSION: Recognizing these risk factors can aid the development of targeted treatment strategies for HS PDA in VLBWIs, enabling early ligation and potentially reducing the need for surgical management.