Neonatal Intensive Care Unit-Level Patent Ductus Arteriosus Treatment Rates and Outcomes in Infants Born Extremely Preterm

Isayama, Tetsuya; Kusuda, Satoshi; Reichman, Brian; Lee, Shoo K.; Lehtonen, Liisa; Norman, Mikael; Adams, Mark; Bassler, Dirk; Helenius, Kjell; Håkansson, Stellan; Yang, Junmin; Jain, Amish; Shah, Prakesh S.; Harrison, Adele; Synnes, Anne; Ting, Joseph; Cieslak, Zenon; Sherlock, Rebecca; Yee, Wendy; Aziz, Khalid; Toye, Jennifer; Fajardo, Carlos; Kalapesi, Zarin; Sankaran, Koravangattu; Daspal, Sibasis; Seshia, Mary; Alvaro, Ruben; Mukerji, Amit; Silva, Orlando da; Nwaesei, Chuks; Lee, Kyong-Soon; Dunn, Michael; Lemyre, Brigitte; Dow, Kimberly; Pelausa, Ermelinda; Barrington, Keith J.; Drolet, Christine; Piedboeuf, Bruno; Claveau, Martine; Beltempo, Marc; Bertelle, Valérie; Massé, Édith; Canning, Roderick; Makary, Hala; Ojah, Cecil; Monterrosa, Luis; Deshpandey, Akhil; Afifi, Jehier; Kajetanowicz, Andrzej; Andersson, Sture; Tammela, Outi; Sankilampi, Ulla; Saarela, Timo; Heymann, Eli; Zangen, Shmuel; Smolkin, Tatyana; Mimouni, Francis; Bader, David A.; Rothschild, Avi; Strauss, Zipora; Felszer, Clari; Omari, Hussam; Tov-Friedman, Smadar Even; Bar‐Oz, Benjamin; Feldman, Michaël; Saad, Nizar; Flidel-Rimon, Orna; Weisbrod, Meir; Lubin, Daniel; Litmanovitz, Ita; Kugelman, Amir; Shinwell, Eric S.; Klinger, G; Nijim, Yousif; Bin‐Nun, Alona; Golan, Agneta; Mandel, Dror; Fleisher-Sheffer, Vered; Kohelet, David; Bakhrakh, Lev; Hattori, Satoshi; Shirai, Masaru; Ishioka, Toru; Mori, Toshihiko; Amizuka, Takasuke; Huchimukai, Toru; Yoshida, Hiroshi; Sasaki, Ayako; Shimizu, Junichi; Nakamura, Toshihiko; Maruyama, Mami; Matsumoto, Hiroshi; Hosokawa, Shinichi; Taki, Atsuko; Nakagawa, Machiko; Ko, Kyone; Uozumi, Azusa; Nakata, Setsuko; Shimazaki, Akira; Yoda, Tatsuya; Numata, Osamu; Imamura, Hiroaki; Kobayashi, Azusa; Tokuriki, Shuko; Uchida, Yasushi; Arai, Takahiro; Ito, Mitsuhiro; Ieda, Kuniko; Ono, Toshiyuki; Hayashi, Masashi; Maki, Kanemasa; Yamakawa, Mie Toru; Kawai, Masahiko; Fujii, Nobutaka; Shiomi, Kozue; Nozaki, Koji; Wada, Hiroshi; Kim, Taho; Tokunaga, Yasuyuki; Takatera, Akihiro; Oshima, T; Sumida, Hiroshi; Michinomae, Yae; Kusumoto, Yoshio; Yoshimoto, Seiji; Morisawa, Takeshi; Ohashi, Tamaki; Takahashi, Yukihiro; Sugimoto, Moriharu; Ono, Noriaki; Miyagawa, Shinichiro; Saijo, Takahiko; Yamagami, Takashi; Koyano, Kosuke; Kobayashi, Shoko; Kanda, Takeshi; Sakemi, Yoshihiro; Aoki, Mikio; Iida, Koichi; Goshi, Mitsushi; Maruyama, Yuko; Kofron, Jiri; Brodd, Katarina Strand; Odlind, Andreas; Alberg, Lars; Arwehed, Sofia; Hafström, Ola; Kasemo, Anna; Nederman, Karin; Åhman, Lars; Ingemarsson, Fredrik; Petersson, Henrik; Thurn, Pernilla; Albinsson, Eva; Selander, Bo; Abrahamsson, Thomas; Heimdahl, Ingela; Sveinsdóttir, Kristbjörg; Wejryd, Erik; Hedlund, Anna; Söderberg, Maria Katarina; Navér, Lars; Brune, Thomas; Bäckström, Jens; Robinson, Johan; Farooqi, Aijaz; Normann, Erik; Fredriksson, Magnus; Palm, Anders; Rosenqvist, Urban; Walde, Bengt; Hagman, Cecilia; Ohlin, Andreas; Florell, Rein; Löfvenberg, Agneta Smedsaas; Meyer, Philipp; Kusche, Rachel; Schulzke, Sven; Nelle, Mathias; Wagner, B. P.; Riedel, Thomas; Kaczala, Grégoire; Pfister, Riccardo; Tolsa, Jean-François; Roth, Matthias; Stocker, Martin; Laubscher, Bernhard; Malzacher, Andreas; Micallef, John P.; Hegi, Lukas; Arlettaz, Romaine; Bernet, Vera

doi:10.1016/j.jpeds.2020.01.069

Cited by 22 publications

(11 citation statements)

References 31 publications

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“…[11] In an analysis of treatment and outcome variation among 6 countries including 139 centers, both low and high PDA treatment rates (combining pharmacotherapy and ligation) were associated with death or severe neurologic injury, whereas a moderate approach was associated with optimal outcome. [4] In our study, we also observed that centers of the low group performed surgical ligations later than those of the high group. According to Benitz, delaying ligation may have advantages as it avoids surgery in many infants in whom the ductus closes without treatment and reduces the risk of postoperative hemodynamic compromise in those who require surgery.…”

Section: Discussionsupporting

confidence: 65%

“…Their reported proportion of surgical ligation (range 6% to 17%) is comparable to ours (11•2%). [4] Swiss adolescents that were surgically ligated during their primary hospitalization reported lower health-related quality of life than their peers. [17] Other authors report adverse outcome after 2 J o u r n a l P r e -p r o o f years associated to surgical ligation, particularly when selective criteria are missing.…”

Section: Discussionmentioning

confidence: 95%

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Outcomes for Infants Born in Perinatal Centers Performing Fewer Surgical Ligations for Patent Ductus Arteriosus: A Swiss Population-Based Study

Adams

Schulzke

Natalucci³

et al. 2021

The Journal of Pediatrics

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 95%

Outcomes for Infants Born in Perinatal Centers Performing Fewer Surgical Ligations for Patent Ductus Arteriosus: A Swiss Population-Based Study

Adams

Schulzke

Natalucci³

et al. 2021

The Journal of Pediatrics

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“…The treatment intervention for PDA in preterm infants varies from the conservative approach ("wait and watchful") to the active, early treatment approach. Recent evidence suggests that mortality may depend on the management of PDA, and a moderate approach is associated with optimal outcomes (19). While in some infants a careful "wait and watchful" strategy may be the best option, other infants may need treatment to minimize the comorbidities in the early postnatal period (20).…”

Section: Discussionmentioning

confidence: 99%

Size of Patent Ductus Arteriosus and Echocardiographic Markers of Shunt Volume in Preterm Infants Based on Postnatal Age

2021

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Objective: This study was conducted in order to compare the strength of correlation between echocardiographic markers of shunt volume and patent ductus arteriosus (PDA) diameter based on postnatal age.Methods: This retrospective study focused on preterm infants (aged <32 weeks of gestation) admitted to the Neonatal Intensive Care Unit of Korea University Ansan Hospital, between April 2014 and December 2017, who studied serial targeted neonatal echocardiography (TNE) for PDA during hospitalization. The association between echocardiographic characteristics and duct size was divided into the following days: within 3 days (very early, VE), 4–7 days after birth (early, E), and after 8 days of birth (late, L).Results: We found 113 assessments conducted on 57 infants in the VE period, 92 assessments on 40 infants in the E period, and 342 assessments on 37 infants in the L period. Median gestational age and birth weight were 28+2 weeks of gestation and 1,115 g, respectively. In the univariate regression analysis, we found a statistically significant correlation between PDA diameter and all TNE markers in the E and L days, but not in the VE period. Only ductal velocity [coefficient of determination (R2) = 0.224], antegrade left pulmonary artery diastolic flow velocity (R2 = 0.165), left ventricular output (LVO)/superior vena cava (SVC) flow ratio (R2 = 0.048), and E/A wave ratio (R2 = 0.092) showed weak correlations with PDA diameter in the VE period. The slopes of the regressions showed significant changes based on postnatal age in the maximum ductal velocity, left atrium/aorta ratio, LVO/SVC flow ratio, and LVO.Conclusions: It is difficult to predict the echocardiographic markers of shunt volume based on the PDA diameter in preterm infants younger than 4 days. A better understanding of the changes in the hemodynamic consequences of PDA based on postnatal age is needed when considering treatment.

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“…Thanks to the tireless efforts and commitment of its director, Prakeshkumar Shah of Toronto, Canada, this collaboration has been the most productive one resulting in more than 20 publications in peer-reviewed journals. Some of the publications focus on comparisons of neonatal outcomes between networks, others link results from a unit-level survey to patient-level cohort data to inform on treatment and outcome variation of patent ductus arteriosus, necrotizing enterocolitis or retinopathy of prematurity (26)(27)(28). To the Swiss neonatologists, they provide highly useful orientation on how neonatal processes are differently performed in other parts of the world and which approach is associated with higher or lower adverse outcome.…”

Section: Current Within Country and Outside Of Country Collaborationmentioning

confidence: 99%

An overview of the Swiss Neonatal Network & Follow-up Group (SwissNeoNet)

Adams¹,

Natalucci²,

Bassler³

2023

Pediatr Med

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The Swiss Neonatal Network Follow-up Group (SwissNeoNet) started as a paper based standardized data collection for very preterm born infants in 1995 for the purpose of research. It has since evolved into a sophisticated online medical registry with the chief aim of improving the quality of medical care for highrisk newborn infants through research, education and collaborative audit. In support of its aim, it collects primary hospitalization and neurodevelopmental follow-up data of various cohorts of newborns from all level III neonatal intensive care units (NICUs) and all peripheral intermediate care level IIB neonatal units (NUs) in Switzerland. It coordinates clinical, epidemiological and health-services research that provide orientation for Swiss neonatologists on how their performance compares with that of other networks, how different approaches in practices without clear evidence base associate with outcome, or how processes and outcomes evolve longitudinally. Its research also allowed former very preterm born children to express their own perception of their quality of life. SwissNeoNet closely monitors and compares NICUs and NUs and provides the infrastructure for quality improvement collaboratives. All units jointly and openly compare their performance and identify potential for changing clinical practices which has led to several local improvement projects as well as revisions of national treatment recommendations. To collaborate in research, to acquire benchmarks, and to serve as a benchmark, SwissNeoNet is actively engaged in several national and international collaborations. Receiving no governmental support, SwissNeoNet struggles with a limited budget to continuously operate a multifaceted, complex network with an electronically advanced, security sensitive infrastructure. Nevertheless, it plans expanding by connecting closer to the families and ultimately the former very preterm born children in the near future: building a patient reported outcome measure (PROM) repository and thus learning more about the parental/patient perspective will benefit clinical research, qualitative research, quality assessment, long-term follow-up recruitment and may even pave the way to later expand into citizen science and personalized health care.

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Neonatal Intensive Care Unit-Level Patent Ductus Arteriosus Treatment Rates and Outcomes in Infants Born Extremely Preterm

Cited by 22 publications

References 31 publications

Outcomes for Infants Born in Perinatal Centers Performing Fewer Surgical Ligations for Patent Ductus Arteriosus: A Swiss Population-Based Study

Outcomes for Infants Born in Perinatal Centers Performing Fewer Surgical Ligations for Patent Ductus Arteriosus: A Swiss Population-Based Study

Size of Patent Ductus Arteriosus and Echocardiographic Markers of Shunt Volume in Preterm Infants Based on Postnatal Age

An overview of the Swiss Neonatal Network & Follow-up Group (SwissNeoNet)

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