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

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

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  • NSTL
  • Elsevier
? 2021 Elsevier Inc.Objective: To assess whether treating patients with a presymptomatic patent ductus arteriosus (PDA), based on early routine echocardiography, performed regardless of clinical signs, improved outcomes. Study design: This multicenter, survey-linked retrospective cohort study used an institutional-level questionnaire and individual patient-level data and included infants of <29 weeks of gestation born in 2014-2016 and admitted to tertiary neonatal intensive care units (NICUs) of 9 population-based national or regional neonatal networks. Infants in NICUs receiving treatment of presymptomatic PDA identified by routine echocardiography and those not were compared for the primary composite outcome (early death [≤7 days after birth] or severe intraventricular hemorrhage) and secondary outcomes (any in-hospital mortality and major morbidities). Results: The unit survey (response rates of 86%) revealed a wide variation among networks in the treatment of presymptomatic PDA (7%-86%). Among 246 NICUs with 17 936 infants (mean gestational age of 26 weeks), 126 NICUs (51%) with 7785 infants treated presymptomatic PDA. The primary outcome of early death or severe intraventricular hemorrhage was not significantly different between the NICUs treating presymptomatic PDA and those who did not (17% vs 21%; aOR 1.00, 95% CI 0.85-1.18). The NICUs treating presymptomatic PDA had greater odds of retinopathy of prematurity treatment (13% vs 7%; aOR 1.47, 95% CI 1.01-2.12); however, it was not significant in a sensitivity analysis excluding Japanese data. Conclusions: Treating presymptomatic PDA detected by routine echocardiography was commonplace but associated with no significant benefits. Well-designed trials are needed to assess the efficacy and safety of early targeted PDA treatment.

echocardiographyinfants born pretermpatent ductus arteriosusquestionnaire survey

Isayama T.、Kusuda S.、Adams M.、Berti E.、Battin M.、Helenius K.、Hakansson S.、Vento M.、Norman M.、Reichman B.、Noguchi A.、Lee S.K.、Bassler D.、Lui K.、Lehtonen L.、Yang J.、Shah P.S.

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Division of Neonatology Center for Maternal-Fetal Neonatal and Reproductive Medicine National

Neonatal Research Network Japan Maternal and Perinatal Center Tokyo Women's Medical University

Swiss Neonatal Network Department of Neonatology University Hospital Zurich and University of Zurich

Neonatal Intensive Care Unit Medical Surgical Fetal-Neonatal Department Anna Meyer Children's

Department of Neonatology Auckland District Health Board

Department of Pediatrics and Adolescent Medicine Turku University Hospital

Department of Clinical Science/Pediatrics Ume? University

Division of Neonatology Health Research Institute La Fe

Department of Neonatal Medicine Karolinska University Hospital and Karolinska Institutet

Gertner Institute for Epidemiology and Health Policy Research Sheba Medical Center

Illinois Neonatal Network Saint Louis University

Department of Pediatrics Mount Sinai Hospital

Department of Newborn Care Royal Hospital for Women and School of Women's and Children's Health

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2022

10.1016/j.jpeds.2021.12.071

The Journal of pediatrics

The Journal of pediatrics

ISSN：0022-3476
年,卷(期)：2022.244
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