Survey of PDA management in very low birth weight infants across Italy

Abstract

Background: The optimal management of PDA in very low birth weight (VLBW) infants is still controversial. Aim of our study was to investigate the management of PDA in the Italian neonatal intensive care units (NICU). Methods: We conducted an on-line survey study from June to September 2017. A 50-items questionnaire was developed by the Italian Neonatal Cardiology Study Group and was sent to Italian NICUs. Results: The overall response rate was 72%. Diagnosis of PDA was done by neonatologists, cardiologists or both (62, 12 and 28% respectively). PDA significance was assessed by a comprehensive approach in all centers, although we found a heterogeneous combination of parameters and cutoffs used. None used prophylactic treatment. 19% of centers treated PDA in the first 24 h, 60% after the first 24 h, following screening echocardiography or clinical symptoms, 18% after the first 72 h and 2% after the first week. In the first course of treatment ibuprofen, indomethacin and paracetamol were used in 87, 6 and 7% of centers respectively. Median of surgical ligation was 3% (1-6%). Conclusions: Significant variations exist in the management of PDA in Italy. Conservative strategy and targeted treatment to infants older than 24 h with echocardiographic signs of hemodynamic significance seemed to be the most adopted approach.

Lung ultrasound in Italian neonatal intensive care units: A national survey

“…Four authors (I. C., B. F., M. S., N. P.) developed a 33-item questionnaire according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) 22 and a previously published survey. 23 The questionnaire was divided into eight sections: epidemiological and organizational characteristics of the center; medical staff assigned to conduct LU; ultrasound equipment for LU; imaging storage and reporting; infection control, cardiorespiratory and thermal stability; practice of LU as "descriptive" tool; practice of LU as "functional" tool; training needs. Survey Monkey was used as an online survey platform.…”

International Variation in the Management of Patent Ductus Arteriosus and Its Association with Infant Outcomes: A Survey and Linked Cohort Study

“…Current opinions vary widely on when and how to detect J o u r n a l P r e -p r o o f 6 PDA, and whether and how to treat it. [1][2][3] Many previous studies reported variable results on the effectiveness of PDA treatment to improve the outcomes of very preterm infants. Most previous studies studied the treatment of symptomatic PDA.…”

Feasibility, Reproducibility and Reference Ranges of Left Atrial Strain in Preterm and Term Neonates in the First 48 h of Life

“…The following echocardiographic measurements were carried out as previously described: shortening fraction (SF), ejection fraction (EF) [ 18 , 22 ], mitral valve Doppler E wave, A wave and E/A ratio, Tissue Doppler Imaging e’, a’, s’; E/e’ ratio [ 23 ], left ventricular output [ 24 ], PDA diameter, PDA maximum velocity, left pulmonary artery (LPA) diastolic velocity and reverse diastolic flow in descending aorta [ 25 ]. A PDA was defined as hemodynamically significant (hsPDA) if the following conditions were fulfilled at 48 h: (1) PDA diameter was > 1.5 mm; (2) maximum velocity of flow across PDA was < 2 m/s; (3) LPA diastolic velocity was > 0.2 m/s; (4) LVO was > 200 mL/kg/min and (5) there was evidence of reverse diastolic flow in descending aorta [ 25 , 26 ].…”