Does oxygen close PDA?

Postnatal increase in oxygen promotes constriction of the patent ductus arteriosus (PDA).

nature.com - Effects of low oxygen saturation limits on the ductus arteriosus in ... - Nature

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Objective:

Postnatal increase in oxygen promotes constriction of the patent ductus arteriosus (PDA). According to the findings of prospective observational studies, the clinical practice of targeting lower fractional oxygen saturation between 70 and 90% has been associated with a reduced incidence of severe retinopathy of prematurity (ROP) without affecting survival or neurodevelopmental disability at 1 year of age. Our objective was to investigate the impact of the use of a lower oxygen saturation target range on the incidence of early hemodynamically significant PDA (hsPDA) and the need for ductal ligation in extremely low birth weight (ELBW, <1000 g) infants.

Study Design:

In this retrospective study, we analyzed data from 263 ELBW infants managed 4 years before (episode I: target oxygen saturation 89 to 94%) and after (episode II: target oxygen saturation 83 to 89%) implementation of the use of lower oxygen saturation limits in two neonatal intensive care units. Infants with a birth weight of 1000 to 1500 g were managed with the same oxygen saturation target range (89 to 94%) during both episodes, and they served as controls. Parametric and nonparametric tests were used as appropriate and multivariate logistic regression models were used to correct for confounders.

Results:

There was an increase in the incidence of hsPDA (63.2 vs 74.8%, P=0.043), without an increase in the need for surgical ligation (24.2 vs 29.9%, P=0.3) after implementation of the lower oxygen saturation target range policy. After adjusting for confounders, there was an increase in the odds of having an hsPDA (odds ratio (OR) 1.77, 95% confidence interval (CI) (1.03 to 3.06), P=0.04) but the odds for ductal ligation did not change in episode II (OR 1.25, 95% CI (0.70 to 2.25), P=0.4). The incidence of ROP⩾stage III (50.7 vs 15.7%; P<0.0001) and the need for laser ablation (33.8% vs 8.7%; P<0.0001) were significantly reduced. There was no change in the incidence of hsPDA or ductal ligation in the control group.

Conclusion:

Targeting lower oxygen saturation limits to minimize periods of hyperoxemia in ELBW infants reduced the incidence of severe ROP and the need for laser ablation. The incidence of early hsPDA was increased; however, final closure rate and the incidence of surgical ligation of the ductus arteriosus were not affected.

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Why would you want to keep a PDA open?

With some congenital heart defects, such as D-type Transposition of the Great Arteries and Pulmonary atresia it is necessary to keep the PDA open in order to ensure the circulation of oxygenated blood to the body tissues.

pted.org - Patent Ductus Arteriosus | Congenital Heart Disease

(GIF Animation, less than 50KB)

How Is It Treated?

If the Patent Ductus Arteriosus remains open in a newborn, pharmaceutical treatment with indomethacin or ibuprofen may be used to encourage its closure. If the PDA still does not close, it is recommended that it be closed either by a cardiac catheterization procedure or surgery. For small to medium size PDAs, the PDA is permanently occluded using coils of spring wire or other devices during a catheterization procedure (see illustration, right). For larger PDAs and PDAs in small infants, the PDA is closed surgically by means of ligation and, in some cases, division (see animation, left). Ligation is the tying off of the ductus (PDA) with a "ligature" (or two ligatures) made of a synthetic material. The vessel may or may not be divided after ligation. With some congenital heart defects, such as D-type Transposition of the Great Arteries and Pulmonary atresia it is necessary to keep the PDA open in order to ensure the circulation of oxygenated blood to the body tissues. This may be achieved through the use of medications (prostaglandin E1) or through a catheterization procedure in which a stent is inserted to keep the PDA open.

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