Patent ductus arteriosus ligation and adverse outcomes: causality or bias?

Dany E Weisz; Patrick J McNamara

doi:10.4103/2249-4847.134670

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Patent ductus arteriosus ligation and adverse outcomes: causality or bias?

Journal article

Open access

Peer reviewed

Patent ductus arteriosus ligation and adverse outcomes: causality or bias?

Dany E Weisz and Patrick J McNamara

Journal of clinical neonatology, Vol.3(2), pp.67-75

04/2014

DOI: 10.4103/2249-4847.134670

PMCID: PMC4089132

PMID: 25024972

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Abstract

Observational studies have associated patent ductus arteriosus (PDA) ligation in preterm infants with increased chronic lung disease (CLD), retinopathy of prematurity, and neurodevelopmental impairment at long-term follow-up. Although the biological rationale for this association is incompletely understood, there is an emerging secular trend toward a permissive approach to the PDA. However, insufficient adjustment for postnatal, pre-ligation confounders, such as intraventricular hemorrhage and the duration and intensity of mechanical ventilation, suggests the presence of residual bias due to confounding by indication, and obliges caution in interpreting the ligation-morbidity relationship. A period of conservative management after failure of medical PDA closure may be considered to reduce the number of infants treated with surgery. Increased mortality and CLD in infants with persistent symptomatic PDA suggests that surgical ligation remains an important treatment modality for preterm infants.

confounding by indication

conservative

neurodevelopmental impairment

mortality

preterm

neurosensory impairment

Chronic lung disease

retinopathy of prematurity

Details

Title: Subtitle: Patent ductus arteriosus ligation and adverse outcomes: causality or bias?
Creators: Dany E Weisz - Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Canada
Patrick J McNamara - Department of Paediatrics, Division of Neonatology, University of Toronto, Toronto, Canada ; Department of Physiology, University of Toronto, Toronto, Canada ; Department of Physiology and Experimental Medicine Program, Hospital for Sick Children Research Institute, Toronto, Canada
Resource Type: Journal article
Publication Details: Journal of clinical neonatology, Vol.3(2), pp.67-75
DOI: 10.4103/2249-4847.134670
PMID: 25024972
PMCID: PMC4089132
NLM abbreviation: J Clin Neonatol
ISSN: 2249-4847
eISSN: 1658-6093
Language: English
Date published: 04/2014
Academic Unit: Stead Family Department of Pediatrics; Neonatology; Internal Medicine
Record Identifier: 9984093483202771

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