CLINICAL-STATISTICAL ANALYSIS AND ADVANCED SURGICAL INTERVENTIONS FOR PATENT DUCTUS ARTERIOSUS (PDA) IN PRETERM AND FULL-TERM NEONATES

Abstract

Background:

Patent ductus arteriosus (PDA) is a common cardiovascular condition in neonates, particularly in preterm infants, where it is associated with significant hemodynamic instability and increased risk of morbidity. Despite advances in neonatal care, optimal management strategies remain controversial.

Objective:

This study aimed to evaluate the clinical characteristics, molecular mechanisms, and treatment outcomes of PDA in preterm and full-term neonates, with particular emphasis on pharmacological therapy and transcatheter closure using the Amplatzer Piccolo occluder.

Methods:

A combined retrospective and prospective clinical study was conducted between 2014 and 2024 in specialized cardiology centers in Uzbekistan. A total of 120 neonates diagnosed with PDA were included and divided into preterm (n=80) and full-term (n=40) groups. Clinical, echocardiographic, and laboratory parameters—including left atrium-to-aortic root ratio (LA/Ao) and NT-proBNP levels—were analyzed. Statistical analysis was performed using SPSS version 26.0, with significance defined as p < 0.05.

Results:

Hemodynamically significant PDA was significantly more prevalent in preterm neonates compared to full-term infants (65% vs 15%, p < 0.01). Pharmacological treatment demonstrated comparable efficacy between ibuprofen (78%) and paracetamol (75%). NT-proBNP levels decreased significantly following successful closure (14,200 ± 2,100 pg/ml vs 3,800 ± 950 pg/ml, p < 0.001), confirming its role as a predictive biomarker. Transcatheter closure using the Amplatzer Piccolo occluder achieved a high success rate with minimal complications and resulted in a 30–40% reduction in pulmonary arterial pressure within 24 hours.

Conclusion:

PDA represents distinct pathophysiological entities in preterm and full-term neonates. Individualized management based on hemodynamic assessment and biomarker monitoring significantly improves clinical outcomes. Minimally invasive transcatheter interventions, particularly the Piccolo occluder, offer a safe and highly effective alternative to surgical ligation, especially in low birth weight infants.