Prognostic factors of premature closure of the ductus arteriosus in utero: a systematic literature review.
BACKGROUND
A number of case reports show various outcomes of premature closure of the ductus arteriosus in utero, including persistent pulmonary hypertension of the newborn and fetal or neonatal death; however, no study clarifies the clinical observations that are related to their prognoses. We aimed to clarify the prognostic factors of intrauterine ductal closure by a systematic literature review. Data sources We searched PubMed database (1975-2014) to identify case reports and studies on intrauterine closure of the ductus arteriosus, including maternal, fetal, and neonatal clinical information and their prognoses.


RESULTS
We analysed the data of 116 patients from 39 articles. Of these, 12 (10.3%) died after birth or in utero. Fetal or neonatal death was significantly correlated with fetal hydrops (odds ratio=39.6, 95% confidence interval=4.6-47.8) and complete closure of the ductus arteriosus (odds ratio=5.5, 95% confidence interval=1.2-15.1). Persistent pulmonary hypertension was observed in 33 cases (28.4%), and was also correlated with fetal hydrops (odds ratio=4.2, 95% confidence interval=1.3-4.6) and complete closure of the ductus arteriosus (odds ratio=5.5, 95% confidence interval=1.6-6.0). Interestingly, maternal drug administration was not correlated with the risk of death and persistent pulmonary hypertension.


CONCLUSIONS
Fetal hydrops and complete ductal closure are significant risk factors for both death and persistent pulmonary hypertension. Cardiac or neurological prognoses could be favourable if the patients overcome right heart failure during the perinatal period.
1Department of Pediatrics,Osaka University Graduate School of Medicine,Osaka,Japan.
Hidekazu
H
Ishida
2Pediatric Cardiology,Osaka Medical Center and Research Institute for Maternal and Child Health,Osaka,Japan.
Yukiko
Y
Kawazu
2Pediatric Cardiology,Osaka Medical Center and Research Institute for Maternal and Child Health,Osaka,Japan.
Futoshi
F
Kayatani
2Pediatric Cardiology,Osaka Medical Center and Research Institute for Maternal and Child Health,Osaka,Japan.
Noboru
N
Inamura
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D004374:Ductus Arteriosus, Patent / Q000150:complications*; D005260:Female; D046689:Fetal Mortality; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D015160:Hydrops Fetalis / Q000453:epidemiology*; D006976:Hypertension, Pulmonary / Q000209:etiology*; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D011247:Pregnancy; D011379:Prognosis; D012307:Risk Factors; D016216:Ultrasonography, Prenatal
D000894:Anti-Inflammatory Agents, Non-Steroidal
Ductus arteriosus; fetal hydrops; intrauterine closure; persistent pulmonary hypertension; prognosis