Here’s an abstract of a study from the most recent Journal of Pediatrics entitled Neurodevelopmental Outcomes of Premature Infants Treated for Patent Ductus Arteriosus: A Population-Based Cohort Study.
Patent Ductus Arteriosus is a condition we all had in the womb, an additional valve between the heart and the lungs. If we’re born at term, the day after we’re born, this closes on its own. If it doesn’t close, it’s called a heart murmur. For preemies, it’s far more common that it does not close. An open PDA can slow growth for the rest of the body that’s not getting enough blood.
Our son, born at 22 weeks and 6 days, had an open PDA. Closing the PDA is challenging — one way is through use of a drug called indomethacin, an anti-inflammatory that is sort of like Advil’s dragon-strength cousin. But, that drug also causes the kidneys to stop working for a while, thus creating a competition between two organs — can we get the PDA to close quickly and then let the kidneys catch up later, or are we going to damage the kidneys?
The other option we were told about was open-heart surgery to tie the PDA closed, an operation that frequently pinched the vocal cords.
We went with the indomethacin, which worked. We’ve never really thought about the long-term consequences of that particular procedure. This study compares children who got treatment for their PDA, either through medication or surgery versus those who did not, and found the ones who got treatment had significantly higher rates of adverse neurodevelopmental outcomes at ages 2-3 years, thus concluding that it might be better to tolerate an open PDA for a while.
One obvious problem here is that the control group is a combination of children who had an open PDA and were not treated and those who did not have PDA to start with. It would make sense that children who never had the problem would suffer fewer long-term consequences. But, it’s still interesting.
And, thanks to James Tooley, on Twitter @jamestooley for posting this.