Abstract
Objective To assess trends in patent ductus arteriosus (PDA) management and examine concurrent
changes in neonatal mortality and morbidities.
Methods This retrospective observational study examined infants born at 23 to 32 weeks' gestational
age with PDA and admitted to a neonatal unit during 2006 to 2012. Multivariable logistic
regression assessed trends in yearly PDA treatment rates and compared a composite
outcome of mortality or any severe morbidity (bronchopulmonary dysplasia, intraventricular
hemorrhage, periventricular leukomalacia, retinopathy of prematurity, or necrotizing
enterocolitis) between and within time periods and PDA treatments.
Results Study subjects included 5,824 preterm neonates with clinical/echocardiographic PDA
diagnosis. During 2006 to 2012, conservative management increased (14–38%), whereas
pharmacotherapy-only (58–49%), surgical ligation-only (7.1–2.5%), and both pharmacotherapy
and surgical ligation (21–10%) decreased (p-values <0.01). From 2006 to 2008 and 2009 to 2012, the composite outcome decreased
for infants managed conservatively (AOR = 0.70, 95% CI 0.52–0.92), with no changes
detected for pharmacotherapy and/or ligation. Lower composite outcome after conservative
management versus pharmacotherapy-only during 2009 to 2012 (AOR = 0.61, 95% CI 0.51–0.74),
but not during 2006 to 2008 reflect significant effect modification by time period.
Conclusion In Canada, during 2006 to 2012, conservative PDA management increased while pharmacotherapy
and/or surgical ligation decreased. Lower composite outcome was detected during later
years after increases in conservative management; however, bias due to unmeasured
confounders remains possible.
Keywords
infant - neonatal morbidities - neonatal mortality - patent ductus arteriosus - premature
