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Am J Perinatol 2017; 34(05): 441-450
DOI: 10.1055/s-0036-1593351
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Trends and Outcomes of Patent Ductus Arteriosus Treatment in Very Preterm Infants in Canada

Armend Lokku
1   Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
2   Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
,
Lucia Mirea
2   Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
3   Research Department, Phoenix Children's Hospital, Phoenix, Arizona
,
Shoo K. Lee
1   Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
2   Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
,
Prakeshkumar S. Shah
1   Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
2   Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
,
on behalf of the Canadian Neonatal Network › Author Affiliations
Further Information

Publication History

07 January 2016

22 August 2016

Publication Date:
20 September 2016 (online)

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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

Supplementary Material

 

  • References

  • 1 Dollberg S, Lusky A, Reichman B. Patent ductus arteriosus, indomethacin and necrotizing enterocolitis in very low birth weight infants: a population-based study. J Pediatr Gastroenterol Nutr 2005; 40 (2) 184-188
    CrossrefPubMedGoogle Scholar
  • 2 Noori S, McCoy M, Friedlich P , et al. Failure of ductus arteriosus closure is associated with increased mortality in preterm infants. Pediatrics 2009; 123 (1) e138-e144
    CrossrefPubMedGoogle Scholar
  • 3 Schena F, Francescato G, Cappelleri A , et al. Association between hemodynamically significant patent ductus arteriosus and bronchopulmonary dysplasia. J Pediatr 2015; 166 (6) 1488-1492
    CrossrefPubMedGoogle Scholar
  • 4 Benitz WE. Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis?. J Perinatol 2010; 30 (4) 241-252
    CrossrefPubMedGoogle Scholar
  • 5 Jain A, Shah PS. Diagnosis, evaluation, and management of patent ductus arteriosus in preterm neonates. JAMA Pediatr 2015; 169 (9) 863-872
    CrossrefPubMedGoogle Scholar
  • 6 Hoellering AB, Cooke L. The management of patent ductus arteriosus in Australia and New Zealand. J Paediatr Child Health 2009; 45 (4) 204-209
    CrossrefPubMedGoogle Scholar
  • 7 Isayama T, Lee SK, Mori R , et al; Canadian Neonatal Network; Neonatal Research Network of Japan. Comparison of mortality and morbidity of very low birth weight infants between Canada and Japan. Pediatrics 2012; 130 (4) e957-e965
    CrossrefPubMedGoogle Scholar
  • 8 Isayama T, Mirea L, Mori R , et al; Neonatal Research Network of Japan and the Canadian Neonatal Network. Patent ductus arteriosus management and outcomes in Japan and Canada: comparison of proactive and selective approaches. Am J Perinatol 2015; 32 (11) 1087-1094
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Chorne N, Leonard C, Piecuch R, Clyman RI. Patent ductus arteriosus and its treatment as risk factors for neonatal and neurodevelopmental morbidity. Pediatrics 2007; 119 (6) 1165-1174
    CrossrefPubMedGoogle Scholar
  • 10 Kabra NS, Schmidt B, Roberts RS, Doyle LW, Papile L, Fanaroff A ; Trial of Indomethacin Prophylaxis in Preterms Investigators. Neurosensory impairment after surgical closure of patent ductus arteriosus in extremely low birth weight infants: results from the Trial of Indomethacin Prophylaxis in Preterms. J Pediatr 2007; 150 (3) 229-234 , 234.e1
    CrossrefPubMedGoogle Scholar
  • 11 Noori S. Patent ductus arteriosus in the preterm infant: to treat or not to treat?. J Perinatol 2010; 30 (Suppl): S31-S37
    CrossrefPubMedGoogle Scholar
  • 12 O'Donovan DJ, Baetiong A, Adams K , et al. Necrotizing enterocolitis and gastrointestinal complications after indomethacin therapy and surgical ligation in premature infants with patent ductus arteriosus. J Perinatol 2003; 23 (4) 286-290
    CrossrefPubMedGoogle Scholar
  • 13 Kaempf JW, Wu YX, Kaempf AJ, Kaempf AM, Wang L, Grunkemeier G. What happens when the patent ductus arteriosus is treated less aggressively in very low birth weight infants?. J Perinatol 2012; 32 (5) 344-348
    CrossrefPubMedGoogle Scholar
  • 14 Laughon M, Bose C, Clark R. Treatment strategies to prevent or close a patent ductus arteriosus in preterm infants and outcomes. J Perinatol 2007; 27 (3) 164-170
    CrossrefPubMedGoogle Scholar
  • 15 Madan JC, Kendrick D, Hagadorn JI, Frantz III ID ; National Institute of Child Health and Human Development Neonatal Research Network. Patent ductus arteriosus therapy: impact on neonatal and 18-month outcome. Pediatrics 2009; 123 (2) 674-681
    CrossrefPubMedGoogle Scholar
  • 16 Mirea L, Sankaran K, Seshia M , et al; Canadian Neonatal Network. Treatment of patent ductus arteriosus and neonatal mortality/morbidities: adjustment for treatment selection bias. J Pediatr 2012; 161 (4) 689-694.e1
    CrossrefPubMedGoogle Scholar
  • 17 Weisz DE, More K, McNamara PJ, Shah PS. PDA ligation and health outcomes: a meta-analysis. Pediatrics 2014; 133 (4) e1024-e1046
    CrossrefPubMedGoogle Scholar
  • 18 Chock VY, Punn R, Oza A , et al. Predictors of bronchopulmonary dysplasia or death in premature infants with a patent ductus arteriosus. Pediatr Res 2014; 75 (4) 570-575
    CrossrefPubMedGoogle Scholar
  • 19 Brooks JM, Travadi JN, Patole SK, Doherty DA, Simmer K. Is surgical ligation of patent ductus arteriosus necessary? The Western Australian experience of conservative management. Arch Dis Child Fetal Neonatal Ed 2005; 90 (3) F235-F239
    CrossrefPubMedGoogle Scholar
  • 20 Canadian Neonatal Network. Canadian Neonatal Network Abstractor's Manual. v 2.1.2, 1–94. 2014. Canadian Neonatal Network. Available at: http://www.canadianneonatalnetwork.org/Portal/LinkClick.aspx?fileticket=krvGeUTtLck%3d&tabid=69 . Accessed August 20, 2015
    PubMedGoogle Scholar
  • 21 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (4) 529-534
    CrossrefPubMedGoogle Scholar
  • 22 International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol 2005; 123 (7) 991-999
    CrossrefPubMedGoogle Scholar
  • 23 Shennan AT, Dunn MS, Ohlsson A, Lennox K, Hoskins EM. Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period. Pediatrics 1988; 82 (4) 527-532
    PubMedGoogle Scholar
  • 24 Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986; 33 (1) 179-201
    PubMedGoogle Scholar
  • 25 Richardson DK, Corcoran JD, Escobar GJ, Lee SK. SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr 2001; 138 (1) 92-100
    CrossrefPubMedGoogle Scholar
  • 26 Kramer MS, Platt RW, Wen SW , et al; Fetal/Infant Health Study Group of the Canadian Perinatal Surveillance System. A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics 2001; 108 (2) E35 DOI: 10.1542/peds.108.2.e35.
    CrossrefPubMedGoogle Scholar
  • 27 Godambe S, Newby B, Shah V, Shah PS. Effect of indomethacin on closure of ductus arteriosus in very-low-birthweight neonates. Acta Paediatr 2006; 95 (11) 1389-1393
    CrossrefPubMedGoogle Scholar
  • 28 Toyoshima K, Momma K, Nakanishi T. In vivo dilatation of the ductus arteriosus induced by furosemide in the rat. Pediatr Res 2010; 67 (2) 173-176
    CrossrefPubMedGoogle Scholar
  • 29 De Buyst J, Rakza T, Pennaforte T, Johansson AB, Storme L. Hemodynamic effects of fluid restriction in preterm infants with significant patent ductus arteriosus. J Pediatr 2012; 161 (3) 404-408
    Google Scholar
  • 30 Fajardo MF, Claure N, Swaminathan S , et al. Effect of positive end-expiratory pressure on ductal shunting and systemic blood flow in preterm infants with patent ductus arteriosus. Neonatology 2014; 105 (1) 9-13
    CrossrefPubMedGoogle Scholar
  • 31 McNamara PJ, Sehgal A. Towards rational management of the patent ductus arteriosus: the need for disease staging. Arch Dis Child Fetal Neonatal Ed 2007; 92 (6) F424-F427
    CrossrefPubMedGoogle Scholar