Changes in the Diagnosis and Management of Patent Ductus Arteriosus from 2006 to 2015 in United States Neonatal Intensive Care Units

Treatment and Nontreatment of the Patent Ductus Arteriosus: Identifying Their Roles in Neonatal Morbidity

“…In this issue of the Journal, Bixler et al (1) examined 61,520 infants (delivered before 31 weeks gestation) in the Pediatrix Clinical Data Warehouse (CDW) and found that both the incidence of patent ductus arteriosus (PDA) reported to the CDW as well as the number of infants receiving PDA treatment (either medical or surgical) declined significantly during the years between 2006 and 2015. Their findings are similar to the results recently reported by Lokku et al (2) from the Canadian Neonatal Network and by Hagadorn et al (3) from the Pediatric Hospital Information System database.…”

“…During the past decade, improvements in clinical care have been associated with a decrease in the incidence of neonatal morbidities that have not been causally linked to the persistence of a PDA (e.g., death, severe IVH, NEC and severe ROP) (1, 52). On the other hand, during the same period the incidence of BPD (which has been causally linked to the presence of a PDA (12, 13, 16, 49, 50)) has remained the same or even increased (1, 3, 52). Although many factors may contribute to the lack of improvement in the incidence of BPD, it is interesting to note that this has occurred during the same time interval that PDA treatment has been in decline (1–3, 52).…”

“…On the other hand, during the same period the incidence of BPD (which has been causally linked to the presence of a PDA (12, 13, 16, 49, 50)) has remained the same or even increased (1, 3, 52). Although many factors may contribute to the lack of improvement in the incidence of BPD, it is interesting to note that this has occurred during the same time interval that PDA treatment has been in decline (1–3, 52). It is also noteworthy that neonatal centers that regularly use prophylactic indomethacin as part of their admission care have significantly lower rates of BPD and BPD/Death than centers that only consider PDA treatment later in the neonatal hospitalization (53).…”

Hemodynamically significant patent ductus arteriosus and the development of bronchopulmonary dysplasia

“…Lokku et al report on the Canadian experience among 5824 infants born prior to 33 weeks in Canada between 2006 and 2012; conservative management of the PDA increased over time, while the rate of BPD decreased. In the United States, Bixler et al report on 61 520 infants born prior to 30 weeks. They compared years 2006‐2010 with 2011‐2015 and show the diagnosis of PDA decreased, medical treatment for PDA decreased, and PDA ligation decreased, while the rate of BPD remained unchanged.…”

Percutaneous closure of the patent ductus arteriosus: opportunities moving forward

“…Over the past decade, our institution (Nationwide Children’s Hospital, NCH) has undergone a marked shift away from surgical PDA ligation, and currently emphasizes conservative management (described below) followed by percutaneous closure for infants needing definitive ductal closure (Figure ) . Changes in the management of PDA closure away from surgical ligation are well described in the literature, however the evidence driving those marked changes is limited. Thus, the primary objectives of this article are to: (a) use rigorous systematic review methodology to assess the quality and quantity of published reports on percutaneous closure vs surgical ligation during infancy; (b) compare outcomes of percutaneous closure vs conservative management; and (c) based on recommendations from the International PDA symposium, to elucidate needs and opportunities for future research and interdisciplinary collaboration.…”