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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

 

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