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. 2017 Apr;139(4):e20162390.
doi: 10.1542/peds.2016-2390.

Trends in Patent Ductus Arteriosus Diagnosis and Management for Very Low Birth Weight Infants

Samantha Ngo  1 , Jochen Profit  2   3 , Jeffrey B Gould  2   3 , Henry C Lee  2   3
Affiliations

Trends in Patent Ductus Arteriosus Diagnosis and Management for Very Low Birth Weight Infants

Samantha Ngo et al. Pediatrics. 2017 Apr.

Abstract

Objective: To examine yearly trends of patent ductus arteriosus (PDA) diagnosis and treatment in very low birth weight infants.

Methods: In this retrospective cohort study of very low birth weight infants (<1500 g) between 2008 and 2014 across 134 California hospitals, we evaluated PDA diagnosis and treatment by year of birth. Infants were either inborn or transferred in within 2 days after delivery and had no congenital abnormalities. Intervention levels for treatment administered to achieve ductal closure were categorized as none, pharmacologic (indomethacin or ibuprofen), both pharmacologic intervention and surgical ligation, or ligation only. Multivariable logistic regression was used to assess risk factors for PDA diagnosis and treatment.

Results: PDA was diagnosed in 42.8% (12 002/28 025) of infants, with a decrease in incidence from 49.2% of 4205 infants born in 2008 to 38.5% of 4001 infants born in 2014. Pharmacologic and/or surgical treatment was given to 30.5% of patients. Between 2008 and 2014, the annual rate of infants who received pharmacologic intervention (30.5% vs 15.7%) or both pharmacologic intervention and surgical ligation (6.9% vs 2.9%) decreased whereas infants who were not treated (60.5% vs 78.3%) or received primary ligation (2.2% vs 3.0%) increased.

Conclusions: There is an increasing trend toward not treating patients diagnosed with PDA compared with more intensive treatments: pharmacologic intervention or both pharmacologic intervention and surgical ligation. Possible directions for future study include the impact of these trends on hospital-based and long-term outcomes.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Flowchart of study population across 134 California hospitals, 2008 to 2014.
FIGURE 2
FIGURE 2
Incidence of PDA in VLBW infants (<1500 g) across 134 California hospitals, 2008 to 2014 (N = 28 025).
FIGURE 3
FIGURE 3
Hospital management of PDA in VLBW infants weighing <1500 g across 134 California hospitals, stratified by treatment intervention level, 2008 to 2014 (N = 28 025).
FIGURE 4
FIGURE 4
Hospital management of PDA in VLBW infants weighing 1000 to 1499 g across 134 California hospitals, stratified by treatment intervention level, 2008 to 2014 (n = 17 188).
FIGURE 5
FIGURE 5
Hospital management of PDA in extremely low birth weight infants weighing <1000 g across 134 California hospitals, stratified by treatment intervention level, 2008 to 2014 (n = 10 837). ELBW, extremely low birth weight infants.
See this image and copyright information in PMC

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