Forthcoming Issue Vol 19 No. 4 Incidence, Associations and Outcomes of Patent Ductus Arteriosus Amongst Neonates in a South African Academic Hospital, 2013 - 2020: A Retrospective Study
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Abstract
Introduction: Patent ductus arteriosus (PDA) is a congenital heart disease (CHD), whereby the ductus arteriosus fails to close within 72 hours after birth. The aetiology of PDA is multifactorial. Well described neonatal associations include prematurity, low birth weight, hypoxic states, infectious states and other coexisting congenital heart defects. Maternal associations include diabetes, hypertension, antenatal care (ANC), advanced maternal age (AMA) and HIV positivity. However, such data is limited to two studies in sub-Saharan Africa
Outcomes: The primary outcome was determining the incidence and trend of PDA at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) from January 2013 to December 2020. The secondary outcomes were to determine the association between neonatal and maternal variables, and the development of a PDA from January 2013 to December 2020 at CMJAH.
Methods: A retrospective record analysis involving 13, 265 neonates admitted to Charlotte Maxeke Johannesburg Academic Hospital, a tertiary hospital in South Africa, from January 2013 to December 2020 was done. Inclusion criteria included confirmed or absent PDA on echocardiography. Exclusion criteria included missing more than 15% of the neonatal and maternal variables.
Results: PDA occurred in 4.6% of the population. On multivariate analysis ELBW and VLBW were significant associations (ELBW: OR=1.884, p = 0.0134; VLBW: OR=2.291, p < 0.001). Other significant associations were CHD (OR=16.485, p < 0.001), Invasive ventilation (OR=3.062, p < 0.001) and AMA (OR=1.692, p = < 0.001). Maternal hypertension emerged as a protective factor (OR=0.474, p < 0.001). Both Sex, as an association, and ANC, as a protective factor, lost significance (OR=1.125, p = 0.3188), (OR=0.755, p = 0.1027) respectively). Various complications and associations such as sepsis after day 3 (OR=8.21, p < 0.001) and necrotising enterocolitis (NEC: OR=4.504, p < 0.001) were strongly associated with PDA on univariate analysis. PDA was also associated a greater length of stay (OR=1.6, p < 0.001).
Conclusions: PDA is a multifactorial disease, and with incidence in this study remaining relatively low. Co-existing congenital heart disease appears to be the most associated variable with PDA. Other significant variables include lower birth weight, invasive ventilation, advanced maternal age, late onset sepsis (after day 3 of life) and maternal hypertension. It was also found that the presence of a PDA significantly prolonged the hospital stay. This study provides insight into PDA in the South Africa setting, it also highlights that that early PDA screening and treatment with paracetamol or ibuprofen may improve mortality and morbidity.
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References
1. Dice JE, Bhatia J. Patent ductus arteriosus: an overview. J Pediatr Pharmacol Ther. 2007 Jul;12(3):138-146. doi: 10.5863/1551-6776-12.3.138.
2. Nizarali Z, Marques T, Costa C, Barroso R, Cunha M. Patent Ductus Arteriosus: Perinatal Risk Factors. J Neonatal Biol. 2012 Sep;1(3): 1-4. doi :10.4172/2167-0897.1000109
3. Fung A, Manlhiot C, Naik S, Rosenberg H, Smythe J, Lougheed J, Mondal T, Chitayat D, McCrindle BW, Mital S. Impact of prenatal risk factors on congenital heart disease in the current era. J Am Heart Assoc. 2013 May 31;2(3):e000064. doi: 10.1161/JAHA.113.000064.
4. Pistulli E, Hamiti A, Buba S, Hoxha A, Kelmendi N, Vyshka G. The Association between Patent Ductus Arteriosus and Perinatal Infection in A Group of Low Birth Weight Preterm Infants. Iran J Pediatr. 2014 Feb;24(1):42-48. https://pmc.ncbi.nlm.nih.gov/articles/PMC4359603/
5. Abu-Sulaiman R, Subaih B. Congenital Heart Disease in Infants of Diabetic Mothers: Echocardiographic Study. Pediatr Cardiol. 2004 Mar-Apr;25(2):137–140. doi: 10.1007/s00246-003-0538-8
6. Hashim ST Jr, Alamri RA, Bakraa R, Rawas R, Farahat F, Waggass R. The Association Between Maternal Age and the Prevalence of Congenital Heart Disease in Newborns from 2016 to 2018 in Single Cardiac Center in Jeddah, Saudi Arabia. Cureus. 2020 Mar 29;12(3):e7463. doi: 10.7759/cureus.7463.
7. Lee JA, Sohn JA, Oh S, Choi BM. Perinatal risk factors of symptomatic preterm patent ductus arteriosus and secondary ligation. Pediatr Neonatol. 2020 Aug;61(4):439-446. doi: 10.1016/j.pedneo.2020.03.016.
8. Hornberger LK, Lipshultz SE, Easley KA, Colan SD, Schwartz M, Kaplan S, Starc TJ, Ayres NA, Lai WW, Moodie DS, Kasten-Sportes C, Sanders SP. Cardiac structure and function in fetuses of mothers infected with HIV: the prospective PCHIV multicenter study. Am Heart J. 2000 Oct;140(4):575-84. doi: 10.1067/mhj.2000.109645.
9. Liu Y, Chen S, Zühlke L, Black GC, Choy MK, Li N, Keavney BD. Global birth prevalence of congenital heart defects 1970-2017: updated systematic review and meta-analysis of 260 studies. Int J Epidemiol. 2019 Apr 1;48(2):455-463. doi: 10.1093/ije/dyz009
10. van der Linde D, Konings EE, Slager MA, Witsenburg M, Helbing WA, Takkenberg JJ, Roos-Hesselink JW. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol. 2011 Nov 15;58(21):2241-7. doi: 10.1016/j.jacc.2011.08.025.
11. Ngubane-Mwandla NAN, Motara F, Ballot, DE. A Cross sectional Descriptive Study of Symptomatic Patent Ductus Arteriosus in Very Low Birth Weight Neonates. Wits J Clin Med. 2019 Jan; 1(2): 69-74. doi:10.18772/26180197.2019.v1n2a3
12. Aldersley T, Lawrenson J, Human P., et al. PROTEA, A Southern African Multicenter Congenital Heart Disease Registry and Biorepository: Rationale, Design, and Initial Results. Front Pediatr. 2021 Oct 20;9:763060. doi: 10.3389/fped.2021.763060. PMID: 34746065; PMCID: PMC8564377.
13. Semberova J, Sirc J, Miletin J, Kucera J, Berka I, Sebkova S, O'Sullivan S, Franklin O, Stranak Z. Spontaneous Closure of Patent Ductus Arteriosus in Infants ≤1500 g. Pediatrics. 2017 Aug;140(2). doi: 10.1542/peds.2016-4258. PMID: 28701390.
14. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009 Apr;42(2):377-381. doi: 10.1016/j.jbi.2008.08.010.
15. Hruşcă A, Căinap S, Răchişan A,L., Pop TL, Chira M, Opriţa S, et al. Congenital heart defects and associated comorbidities – 5 years of experience. Human and Veterinary Medicine 2013 08;5(2):62-65.
16. Gillam-Krakauer M, Mahajan K. Patent Ductus Arteriosus. 2022 Aug 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. https://pubmed.ncbi.nlm.nih.gov/28613509/
17. Kusuma A, Gunawijaya E, Putra I, Yantie N, Kardana IM, Lingga D, Gustawan IW. Risk Factors of Patent Ductus Arteriosus in Preterm. Am J Pediatr. 2020 Jun; 6(2): 168-172. doi: 10.11648/j.ajp.20200602.29
18. Terrin G, Di Chiara M, Boscarino G, Metrangolo V, Faccioli F, Onesta E, Giancotti A, Di Donato V, Cardilli V, De Curtis M. Morbidity associated with patent ductus arteriosus in preterm newborns: a retrospective case-control study. Ital J Pediatr. 2021 Jan; 47(9). https://doi.org/10.1186/s13052-021-00956-2.