Am J Perinatol 2017; 34(10): 0990-0995
DOI: 10.1055/s-0037-1601442
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Changing Management of the Patent Ductus Arteriosus: Effect on Neonatal Outcomes and Resource Utilization

Valerie Y. Chock
1   Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California
,
Veena V. Goel
2   Pediatric Hospital Medicine, Stanford University School of Medicine, Palo Alto, California
3   Clinical Informatics, Stanford University School of Medicine, Palo Alto, California
,
Jonathan P. Palma
1   Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California
3   Clinical Informatics, Stanford University School of Medicine, Palo Alto, California
,
Thomas M. Luh
1   Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California
,
Nichole A. Wang
1   Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California
,
Shabnam Gaskari
4   Pediatric Pharmacy, Stanford University School of Medicine, Palo Alto, California
,
Rajesh Punn
5   Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California
,
Norman H. Silverman
5   Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California
,
William E. Benitz
1   Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California
› Author Affiliations
Further Information

Publication History

23 November 2017

28 February 2017

Publication Date:
04 April 2017 (online)

Abstract

Objective This historical cohort study investigated how a shift toward a more conservative approach of awaiting spontaneous closure of the patent ductus arteriosus (PDA) in preterm infants has affected neonatal outcomes and resource utilization.

Methods We retrospectively studied very low birth weight infants diagnosed with a PDA by echocardiogram (ECHO) in 2006–2008 (era 1), when medical or surgical PDA management was emphasized, to those born in 2010–2012 (era 2) when conservative PDA management was encouraged. Multiple regression analyses adjusted for gestational age were performed to assess differences in clinical outcomes and resource utilization between eras.

Results More infants in era 2 (35/89, 39%) compared with era 1 (22/120, 18%) had conservative PDA management (p < 0.01). Despite no difference in surgical ligation rate, infants in era 2 had ligation later (median 24 vs. 8 days, p < 0.0001). There was no difference in clinical outcomes between eras, while number of ECHOs per patient was the only resource measure that increased in era 2 (median 3 vs. 2 ECHOs, p = 0.003).

Conclusion In an era of more conservative PDA management, no increase in adverse clinical outcomes or significant change in resource utilization was found. Conservative PDA management may be a safe alternative for preterm infants.

 
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