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

Tetsuya Isayama; Satoshi Kusuda; Mark Adams; Elettra Berti; Malcolm Battin; Kjell Helenius; Stellan Håkansson; Maximo Vento; Mikael Norman; Brian Reichman; Akihiko Noguchi; Shoo K Lee; Dirk Bassler; Kei Lui; Liisa Lehtonen; Junmin Yang; Prakesh S Shah; International Network for Evaluating Outcomes of Neonates (iNeo) Investigators

doi:10.1016/j.jpeds.2021.12.071

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

J Pediatr. 2022 May:244:24-29.e7. doi: 10.1016/j.jpeds.2021.12.071. Epub 2022 Jan 4.

Authors

Tetsuya Isayama¹, Satoshi Kusuda², Mark Adams³, Elettra Berti⁴, Malcolm Battin⁵, Kjell Helenius⁶, Stellan Håkansson⁷, Maximo Vento⁸, Mikael Norman⁹, Brian Reichman¹⁰, Akihiko Noguchi¹¹, Shoo K Lee¹², Dirk Bassler³, Kei Lui¹³, Liisa Lehtonen⁶, Junmin Yang¹⁴, Prakesh S Shah¹⁵; International Network for Evaluating Outcomes of Neonates (iNeo) Investigators

Affiliations

¹ Division of Neonatology, Center for Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
² Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan.
³ Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
⁴ Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, Anna Meyer Children's University Hospital, Florence, Italy.
⁵ Department of Neonatology, Auckland District Health Board, Auckland, New Zealand.
⁶ Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland; Department of Clinical Medicine, University of Turku, Turku, Finland.
⁷ Department of Clinical Science/Pediatrics, Umeå University, Umeå, Sweden.
⁸ Division of Neonatology, Health Research Institute La Fe, Valencia, Spain.
⁹ Department of Neonatal Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
¹⁰ Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel.
¹¹ Illinois Neonatal Network, Saint Louis University, Saint Louis, IL.
¹² Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
¹³ Department of Newborn Care, Royal Hospital for Women and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
¹⁴ Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.
¹⁵ Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. Electronic address: Prakeshkumar.Shah@sinaihealth.ca.

PMID: 34995641
DOI: 10.1016/j.jpeds.2021.12.071

Abstract

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.

Keywords: echocardiography; infants born preterm; patent ductus arteriosus; questionnaire survey.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Cerebral Hemorrhage
Child
Cohort Studies
Ductus Arteriosus, Patent* / drug therapy
Ductus Arteriosus, Patent* / therapy
Humans
Infant
Infant, Low Birth Weight
Infant, Newborn
Retrospective Studies
Surveys and Questionnaires

Grants and funding

APR-126340 /CIHR/Canada