Study suggests shift away from pharmacologic management of patent ductus arteriosus

1. Between 2008 and 2014, rates of pharmacologic treatment or pharmacologic plus surgical ligation of patent ductus arteriosus (PDA) in very low birth weight (VLBW) infants decreased, while percent of infants not treated or treated with ligation alone increased.

2. Incidence of PDA diagnosis in very low birth weight infants decreased from 50% to 39.5% between 2008 and 2014.

Evidence Rating Level: 2 (Good)

Study Rundown: Treatment options for PDA range from conservative (observation only, allowing for spontaneous closure) to intensive (pharmacologic and/or surgical interventions). While varying combinations of these treatment options have been practiced for years, there is no clear standard of care to guide PDA management. This retrospective cohort study aimed to characterize practice patterns and identify shifts in PDA treatment among VLBW infants between 2008 and 2014. Researchers analyzed treatment data from 134 hospitals affiliated with the California Perinatal Quality Care Collaborative (CPQCC). Results showed a significant decrease in incidence of PDA diagnosis throughout the duration of the 7-year study. Findings also demonstrated a shift away from pharmacologic treatment of PDA, with increasing rates of observation allowing for spontaneous closure or primary surgical ligation. One limitation is this study’s exclusive focus on infants treated with observation alone or pharmacologic and/or surgical interventions; use of management techniques may have influenced treatment trends in other ways. Other limitations of this study include failure to describe specific details on how PDA was diagnosed and failure to characterize factors that may have contributed to changes in PDA diagnosis over this time period. Findings from this study have implications for characterizing relationships between PDA treatments and long-term health outcomes.

Click to read the study, published today in Pediatrics

Relevant reading: Diagnosis, Evaluation and Management of Patent Ductus Arteriosus in Preterm Neonates

In-Depth [retrospective cohort]: Using data collected through the CPQCC on live births at 134 hospitals between 2008 and 2014, researchers attempted to characterize incidence of PDA diagnosis among VLBW infants and describe rates of treatments for PDA. Patients were first divided into 2 groups based on whether they had a PDA diagnosis using the criteria set forth by the CPQCC. Patients with PDA were further categorized into 4 groups based on intervention: no pharmacologic or surgical intervention, pharmacologic intervention only, pharmacologic and surgical interventions, and surgical ligation only. Results showed that the incidence of VLBW infants diagnosed with PDA decreased from 49.2% in 2008 to 38.5% in 2014 (P<.0001). Results also showed significant changes in PDA treatment trends during the study period. Rates of infants who received no intervention increased from 60.5% to 78.3% (P<.0001) between 2008 and 2014. A smaller change was seen in percent of patients underwent primary surgical ligation (2.2% to 3.0%) Conversely, rates of infants receiving pharmacologic intervention alone or both pharmacologic and surgical intervention decreased during the study period (30.5% to 15.7%, and 6.9% to 2.9% respectively). Several factors were associated with higher odds of being diagnosed with a PDA and of receiving PDA treatment: being born outside the hospital (OR 1.78 and 1.48 respectively), cesarean delivery (OR 1.39 and 1.40), and multiple gestation (OR 1.20 and 1.21). Similarly, lower odds of both diagnosis and treatment of PDA were associated with older gestational age (OR 0.64 and 0.63) and 5-minute APGAR score of 0 to 3 (OR 0.58 and 0.56).

Image: PD

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