Timing of Early Device Closure of Patent Ductus Arteriosus in Premature Infants

Background: The aim of the study was to determine if there is an association between catheter-based occlusion of an arterial duct in premature infants and the incidence of necrotizing enterocolitis. Methods: This was a single center retrospective observational case control study. Infants born between 7/2018 and 12/2022, who were either born prior to 32 weeks gestation or weighed less than 1500 grams and had a patent arterial duct that received medical management, device closure, or surgical ligation were included. Group 1 consisted of infants born prior to 2020 who received only medical therapy and group 2 consisted of those who were born after 2020 and received catheter-based intervention. Analyses were conducted to determine if the incidence of necrotizing enterocolitis had changed since the introduction of catheter-based intervention at the institution in 2020. Results: There were 101 infants which met the inclusion criteria. Group 1 (n = 24) was prior to 2020 with medical management only, and group 2 (n = 77), 2020 onward with introduction of catheter-based occlusion. There were no significant changes in patient characteristics or any management options other than the introduction of device closure between the two groups. Development of necrotizing enterocolitis was shown to be at a median of 31 days and device closure at 49 days. There was a decreasing trend in the institutional incidence of necrotizing enterocolitis (2.6% vs 1.7%). Conclusion: Although we were unable to demonstrate statistical significance in the reduction of necrotizing enterocolitis between the groups, this may be due to the demonstrated need to intervene earlier as well as a larger sample size.