Treatment strategies to prevent or close a patent ductus arteriosus in preterm infants and outcomes

Laughon, Matthew M.; Bose, Carl; Clark, Reese H.

doi:10.1038/sj.jp.7211662

Cited by 77 publications

(67 citation statements)

References 14 publications

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“…In the setting of surgical ligation, severe IVH is a potential confounder. It has been associated with PDA ligation 45,52,62 and NDI [161][162][163][164][165] and is not typically on the causal pathway between PDA ligation and NDI. Most IVH (90%) occurs in the first week of life, 166 preceding the timing of surgical ligation reported in most studies.…”

Section: Figurementioning

confidence: 99%

PDA Ligation and Health Outcomes: A Meta-analysis

et al. 2014

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BACKGROUND AND OBJECTIVE: Patent ductus arteriosus (PDA) ligation has been variably associated with neonatal morbidities and neurodevelopmental impairment (NDI). The objective was to systematically review and meta-analyze the impact of PDA ligation in preterm infants at <32 weeks’ gestation on the risk of mortality, severe neonatal morbidities, and NDI in early childhood. METHODS: Medline, Embase, Cochrane Central Register of Controlled Trials, Education Resources Information Centre (ERIC), Cumulative Index to Nursing and Allied Health (CINAHL), PsycINFO, and the Dissertation database were searched (1947 through August 2013). Risk of bias was assessed by using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool. Meta-analyses were performed by using a random-effects model. Unadjusted and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were pooled when appropriate. RESULTS: Thirty-nine cohort studies and 1 randomized controlled trial were included. Nearly all cohort studies had at least moderate risk of bias mainly due to failure to adjust for survival bias and important postnatal preligation confounders such as ventilator dependence, intraventricular hemorrhage, and sepsis. Compared with medical treatment, surgical ligation was associated with increases in NDI (aOR: 1.54; 95% CI: 1.01–2.33), chronic lung disease (aOR: 2.51; 95% CI: 1.98–3.18), and severe retinopathy of prematurity (aOR: 2.23; 95% CI: 1.62–3.08) but with a reduction in mortality (aOR: 0.54; 95% CI: 0.38–0.77). There was no difference in the composite outcome of death or NDI in early childhood (aOR: 0.95; 95% CI: 0.58–1.57). CONCLUSIONS: Surgical ligation of PDA is associated with reduced mortality, but surviving infants are at increased risk of NDI. However, there is a lack of studies addressing survival bias and confounding by indication.

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Section: Figurementioning

confidence: 99%

PDA Ligation and Health Outcomes: A Meta-analysis

et al. 2014

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“…These data are stored in a consolidated data set and then de-identified for quality assurance, research and billing purposes. By using the de-identified data set, from which several other observations have been reported, [16][17][18] we performed a retrospective case series review of neonates with a diagnosis of MAS. Cases were identified by searching the diagnosis table in our database for the term 'meconium aspiration syndrome.'…”

Section: Diagnosismentioning

confidence: 99%

Meconium aspiration syndrome remains a significant problem in the NICU: outcomes and treatment patterns in term neonates admitted for intensive care during a ten-year period

Clark²,

et al. 2009

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Objective: The purpose of this study was to evaluate the demographic and treatment characteristics of neonates (X37 weeks' estimated gestational age) who were admitted to a neonatal intensive care unit (NICU) for a diagnosis of meconium aspiration syndrome (MAS) during the years 1997 to 2007. The goals in studying this group of neonates were to better estimate the magnitude of abnormal outcomes and to determine the proportion of these infants exposed to specific therapeutic interventions.Study Design: Retrospective review of an administrative de-identified data set.Result: A total of 415 772 neonates formed the starting data set and 162 075 (39%) were X37 weeks. Of the 162 075 term neonates, 7518 (1.8% of all neonates and 4.6% of term NICU admissions) had an admission diagnosis of MAS. In the 7518 neonates, the following outcomes were observed: 6124 (81.5%) were discharged home; 679 (9%) were acutely transferred to a higher level of intensive care; 416 (5.5%) were transferred to another clinical service within the hospital; 178 (2.4%) were transferred to another NICU for convalescent care and 88 (1.2%) died. There were 33 (0.4%) who did not have data on outcome at discharge. During the period between 2002 and 2005, acute transfer rates decreased (12.4 to 9%) and the reported rate for death remained relatively constant between 0.9 and 1.5%. There were 107 (1.4%) neonates who were treated (n ¼ 61) with, or transferred, for extracorporeal membrane oxygenation (ECMO) (n ¼ 46). Three of the sixty-one neonates (4.9%) who were treated with ECMO died. Conclusion:Term neonates who are admitted with a diagnosis of MAS continue to represent a high-risk population with significant morbidity, and they often require intensive therapies.

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“…These data are stored in a consolidated data set and then de-identified for quality improvement and research. Using the de-identified data set, from which several other observations have been reported, [8][9][10] we performed a retrospective case series review of neonates with a report of having been treated with iNO. Cases were identified by searching the respiratory support and medications table in our database for the term 'nitric oxide.'…”

Section: Data Setmentioning

confidence: 99%

The changing pattern of inhaled nitric oxide use in the neonatal intensive care unit

et al. 2010

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Objective: The purpose of this study was to evaluate the demographic characteristics and outcomes of neonates who were admitted to a neonatal intensive care unit and treated with inhaled nitric oxide (iNO) during the years 2000-08. The goal of studying this group of neonates was to evaluate how iNO use has evolved in infants and to estimate the frequency of off-label use of this drug in this population.Study Design: Retrospective review of the Pediatrix Clinical Data Warehouse de-identified data set. Pediatrix Medical Group provides intensive care services in 244 hospitals in 32 states and Puerto Rico. Nine (3.7%) centers provide extracorporeal membrane oxygenation.Result: There were 494 255 neonates in the data set; 4316 (0.9%) were treated with iNO. The use of iNO increased from 154 of 32 967 patients in 2000 to 921 of 75 911 patients in 2008; a 2.6-fold increase (0.47 to 1.23%). There were 155 872 infants <34 weeks estimated gestational age discharged between 1 January 2000 and 31 December 2008; 1656 (1.1%) were treated with iNO. Since approval in 2000, the reported use of iNO in neonates <34 weeks increased from 0.3 to 1.8% in 2008; a sixfold increase in the reported use of iNO. The biggest increase occurred in infants between 23 and 26 weeks' gestational age (0.8 to 6.6%). In contrast, the increase in iNO use among neonates born X34 weeks has only increased from 0.5 to 1%. Conclusion:The use of iNO has increased and the greatest increase has been the off-label use among preterm neonates. Journal of Perinatology (2010) In a meta-analysis of clinical studies involving term and late preterm neonates, Finer and Barrington 1 concluded that 'based on the evidence presently available, including the neurodevelopmental and general medical outcome information, near-term and term infants with hypoxic respiratory failure unresponsive to other therapy, excluding infants with diaphragmatic hernia, should have a trial of inhaled nitric oxide.' 1 The use of iNO in more premature (<34 weeks) infants has generally focused on two high-risk groups; those with severe acute respiratory distress 2,3 and those at high risk of developing bronchopulmonary dysplasia (BPD). [4][5][6] In a recent meta-analysis of the published clinical studies involving preterm infants, Barrington and Finer 7 concluded that 'y iNO should not be routinely used for preterm infants as a rescue therapy in cases of hypoxic respiratory failure. In contrast, the early routine use of iNO in ventilated preterm infants who are not severely ill, but nevertheless are at risk for serious brain injury or bronchopulmonary dysplasia, holds promise.' 7 The purpose of our study was to determine whether changes in practice are consistent with the suggestions of these two meta-analyses; more specifically, our goal was to evaluate how the off-label use of iNO has changed since its approval in late 1999.

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Treatment strategies to prevent or close a patent ductus arteriosus in preterm infants and outcomes

Cited by 77 publications

References 14 publications

PDA Ligation and Health Outcomes: A Meta-analysis

PDA Ligation and Health Outcomes: A Meta-analysis

Meconium aspiration syndrome remains a significant problem in the NICU: outcomes and treatment patterns in term neonates admitted for intensive care during a ten-year period

The changing pattern of inhaled nitric oxide use in the neonatal intensive care unit

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