(3) Exposure to Hemodynamically Significant Patent Ductus Arteriosus and Feeding Outcomes in Very Preterm Infants. a Retrospective Cohort Study

Background: One in ten children born in the United States is premature. Preterm birth is associated with increased risk of medically complex conditions requiring highly specialized care and prolonged hospitalization. The prevalence of oral feeding difficulties is higher in this population, accounting for 21-37% of infants admitted at 36 weeks post-menstrual age (PMA). A hemodynamically significant patent ductus arteriosus (hsPDA) is a risk factor for significant delay in enteral feeding introduction or longer interval between first feed and full enteral feed achievement, leading to prolonged hospitalization

Objectives: Identify the association of duration of exposure to hsPDA with the achievement of full oral feeds at 36 and 38 weeks PMA, at discharge and length of hospital stay

Design/Methods: Retrospective cohort analysis of infants born at ≤29 6/7 weeks gestation in the University of Iowa NICU from January 1 2019 to June 30 2024. Descriptive statistics will report demographics and feeding milestones. Patients will be classified by gestational age. Dichotomous outcomes will be described with proportions. Continuous outcomes will use means with SD if normally distributed, otherwise medians with IQR. Univariable analysis will assess demographics and outcomes followed by multivariable logistic regression

Results: A total of 404 infants were included. The mean gestational age was 26.6 weeks (±2.1) and the mean birth weight was 930 grams (±312). Median initiation of oral feeds was at day 63 (IQR: 46-97). Median time to full oral feeds was 20 days (IQR: 13-28). For infants with hsPDA, median initiation of oral feeds was at day 80 (IQR: 59-110) and time to full oral feeds was 20 days (IQR: 13-28). By discharge, 82% achieved oral independence (86% without hsPDA, 79% with hsPDA), 12% required a combination of oral and tube feedings (14% without hsPDA, 22% with hsPDA), and 4% were exclusively tube fed. 35% were diagnosed with hsPDA, with 70% responding to pharmacological interventions and 30% requiring definitive closure. The mean PMA at discharge was 42.4 weeks (±5.4) and the mean hospital stay was 110 days (±47). For hsPDA, the stay was 126 days vs. 92 days without hsPDA

Conclusions: Premature infants born at ≤29 6/7 weeks gestation with hsPDA experienced delayed oral feed introduction and prolonged time to achieve full oral independence at 36 and 38 weeks PMA and at discharge. They also had a higher need for supplemental tube feeding and longer hospital stay