121 - Short-term respiratory outcomes after transcatheter PDA Closure in a level IV NICU: A single-center retrospective study

Poster Number: 121
Publication Number: 121.2152

Background: Hemodynamically significant Patent ductus arteriosus (HsPDA) is often associated with significant respiratory morbidities in preterm infants. Many patients are referred to our center for transcatheter device closure of PDA (TCPC). It is known that TCPC is associated with a significantly lower risk of post-PDA ligation syndrome. However, closure of HsPDA is associated with cardiac and pulmonary changes in preterm infants. Limited data exists regarding the short-term cardiorespiratory changes in infants after TCPC.

Objective: The aim of this study was to study the short term effect of TCPC on the cardiorespiratory status of neonates and to assess the risk factors associated with worse short-term respiratory outcomes.

Design/Methods: This was a retrospective study performed at a level IV NICU. All consecutive infants who underwent TCPC and were on invasive mechanical ventilation prior to PDA closure between January 2022 to December 2022 were included in this study. Patient charts were reviewed and their demographic information, cardiorespiratory status, echocardiography findings and outcomes were recorded. Continuous variables were expressed as mean +/-SD and categorical variables were expressed as absolute and relative frequencies. A prior study showed a higher risk of requiring high frequency ventilation (HFV) in infants with 1 hour post-procedure respiratory severity score (RSS) ≥ 4. We divided the infants into two groups based on pre-procedure RSS. T-test, Mann-Whitney U test and Chi-squared tests were used to compare the two groups.

Results: Forty-seven infants satisfied the inclusion criteria. Of these, one infant was excluded due to a right atrial perforation during TCPC leading to a prolonged cardiorespiratory course. 46 infants were included in this study. The pre-procedure characteristics and the post-procedure course are shown in Tables 1 and 2, respectively. Pre-procedure RSS ≥ 4 was associated with a higher rate of HFV both pre- and post- TCPC. In our study, no patient who was previously on conventional ventilation (CMV) transitioned to HFV post-TCPC, whereas one patient was switched from HFV to CMV post-procedure. While no patient was on vasoactive medications prior to TCPC, four patients required vasoactive medications after procedure.

Conclusion(s): TCPC was tolerated well in our study with no significant short-term cardiopulmonary decompensation. Pre-procedure RSS ≥ 4 was associated with a significantly higher RSS up to 48 hours post-procedure and hence, may be used to identify infants who need closer monitoring after TCPC.