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

Abstract

OBJECTIVE To assess whether treating patients with a pre-symptomatic 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' gestation born in 2014-16 and admitted to tertiary neonatal intensive care units (NICUs) of nine population-based national or regional neonatal networks. Infants in NICUs receiving treatment of pre-symptomatic 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 [IVH]) 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 pre-symptomatic PDA (7%-86%). Among 246 NICUs with 17936 infants (mean gestational age of 26 weeks), 126 NICUs (51%) with 7785 infants treated pre-symptomatic PDA. The primary outcome of early death or severe IVH was not significantly different between the NICUs treating pre-symptomatic PDA and those who did not (17% vs 21%; adjusted odds ratio [aOR] 1.00, 95% confidence interval [95%CI] 0.85-1.18). The NICUs treating pre-symptomatic PDA had higher odds of retinopathy of prematurity (ROP) 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 pre-symptomatic 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