Trends and variation in management and outcomes of very low-birth-weight infants with patent ductus arteriosus

Hagadorn, James I.; Brownell, Elizabeth A.; Trzaski, Jennifer; Johnson, Kendall R.; Lainwala, Shabnam; Campbell, Brendan T.; Herbst, Katherine W.

doi:10.1038/pr.2016.166

Cited by 83 publications

(68 citation statements)

References 28 publications

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“…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. Although these studies demonstrate that there has been a decline in both the desire to investigate the presence of a PDA, as well as to treat it when present, they cannot tell us whether this trend toward “non-treatment” (or “conservative” management) has been applied primarily to infants with small, insignificant left-to-right PDA shunts or whether infants with moderate/large PDA shunts also have been included in this approach.…”

supporting

confidence: 92%

“…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).…”

mentioning

confidence: 99%

“…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).…”

mentioning

confidence: 99%

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

Clyman¹,

Liebowitz

2017

The Journal of Pediatrics

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supporting

confidence: 92%

mentioning

confidence: 99%

mentioning

confidence: 99%

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

Clyman¹,

Liebowitz

2017

The Journal of Pediatrics

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“…Nevertheless, many infants are treated with medications in an attempt to close the PDA, and many others undergo surgical closure, usually after failed pharmacologic treatment [4]. Any treatment strategy should maximize efficacy and minimize toxicity.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of pharmacologic closure of patent ductus arteriosus in small-for-gestational-age extremely preterm infants

Boghossian

Tiddi

Bell

et al. 2017

Early Human Development

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Background Optimal management of the patent ductus arteriosus (PDA) in preterm infants remains controversial. Therefore, studies identifying infants who are most likely to benefit from PDA treatment are needed. Aim We sought to examine if significant intrauterine growth restriction, defined by birth weight z-score, reduces the efficacy of PDA closure with indomethacin or ibuprofen and thereby increases the need for surgical closure of PDA after pharmacologic treatment. Study design, subjects, and outcome measures We studied infants 23–28 weeks’ gestation born 2006–2013 at NICHD Neonatal Research Network centers. We examined the responses to PDA treatment with indomethacin and/or ibuprofen and whether the PDA was subsequently closed surgically. Logistic regression generated adjusted odds ratios (ORs) for the associations between the z-score groups (<−2, −2 to −0.5, and >−0.5) and PDA surgery following pharmacologic treatment. Results 5,606 infants were diagnosed with PDA; 3,587 (64.0%) received indomethacin or ibuprofen or both, and 909 (25.3%) underwent PDA surgery. Mothers of infants with PDA non-closure were less likely to have hypertension (19% vs. 28%). Infants with non-closure were more likely to be female (53% vs. 49%), have lower gestational age and birth weight and to develop sepsis (42% vs. 31%). Compared to infants with z-score >−0.5, PDA surgery was increased among infants with z-score −2 to −0.5 (OR=1.23; 95% CI 1.02–1.47) but not among infants with z-score <−2. Conclusion Infants with birth weight z-score −2 to −0.5 are more likely than normally grown infants to require PDA surgery following pharmacologic treatment.

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“…A retrospective study of 13 853 VLBW infants in the Pediatric Hospital Information System (PHIS) database found that use of interventions to close PDA decreased by 11% per year from 2005 to 2014 . This practice change was temporally associated with increases in unadjusted rates of bronchopulmonary dysplasia, periventricular leukomalacia, retinopathy of prematurity, and acute renal failure, but also with improved survival.…”

Section: Evidence From Population Surveysmentioning

confidence: 99%

PDA: To treat or not to treat

Bhombal

Benitz

2019

Congenital Heart Disease

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Management of patent ductus arteriosus in extremely preterm infants remains a topic of debate. Treatment to produce ductal closure was widely practiced until the past decade, despite lack of evidence that it decreases morbidities or mortality. Meta‐analyses of trials using nonsteroidal anti‐inflammatory drugs have shown effectiveness in accelerating ductal closure, but no reduction in neonatal morbidities, regardless of agent used, indication, timing, gestational age, or route of administration. Surgical ligation closes the ductus but is associated with adverse effects. Recent experience with conservative approaches to treatment suggest improved neonatal outcomes and a high rate of spontaneous ductal closure after discharge. Careful postdischarge follow‐up is important, however, because potential adverse effects of long‐standing aortopulmonary shunts may be an indication for catheter‐based ductal closure. Identification of extremely preterm infants at greatest risk of potential harm from a persistently patent ductus, who may benefit most from treatment are urgently needed.

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Trends and variation in management and outcomes of very low-birth-weight infants with patent ductus arteriosus

Abstract: Use of cyclooxygenase inhibitors and ligation for PDA in VLBW infants decreased over a 10-y period at the studied hospitals. Further evidence is needed to assess the impact of this change in PDA management.

Cited by 83 publications

References 28 publications

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

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

Efficacy of pharmacologic closure of patent ductus arteriosus in small-for-gestational-age extremely preterm infants

PDA: To treat or not to treat

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