Outcomes for Infants Born in Perinatal Centers Performing Fewer Surgical Ligations for Patent Ductus Arteriosus: A Swiss Population-Based Study - 22/09/21

Doi : 10.1016/j.jpeds.2021.06.030

Mark Adams, PhD ^1,^2,^⁎ , Sven M. Schulzke, MD, MSc ³ : Prof, Giancarlo Natalucci, MD ^1,^2,⁴ : Prof, Juliane Schneider, MD ⁵, Thomas Riedel, MD ⁶, Cristina Borradori Tolsa, MD ⁷, Riccardo Pfister, MD ⁷ : Prof, Dirk Bassler, MD, MSc ¹ : Prof
for the
Swiss Neonatal Network & Follow-Up Group^∗
List of additional members of the Swiss Neonatal Network and Follow-up Group is available at www.jpeds.com (Appendix).
Philipp Meyer, MD, Rachel Kusche, Andrea Capone Mori, MD, Daniela Kaeppeli, MD, Sven M. Schulzke, MD : Prof, Marc Brotzmann, MD, Gian Paolo Ramelli, MD : Prof, Barbara Simonetti Goeggel, Jane McDougall, MD : Prof, Tilman Humpl, MD : Prof, Maja Steinlin, MD : Prof, Sebastian Grunt, PD, MD, Mathias Gebauer, MD, Ralph Hassink, MD, Thomas Riedel, PD, MD, Elmar Keller, MD : Prof, Christa Killer, MD, Gaelle Blanchard, MD, Riccardo E. Pfister, MD : Prof, Petra S. Huppi, MD : Prof, Cristina Borradori-Tolsa, MD, Jean-François Tolsa, MD : Prof, Matthias Roth-Kleiner, MD : Prof, Myriam Bickle-Graz, MD, Martin Stocker, PD, MD, Thomas Schmitt-Mechelke, MD : Prof, Florian Bauder, MD, Bernd Erkert, MD, Anita Mueller, MD, Marc Ecoffey, MD, Andreas Malzacher, MD, Bjarte Rogdo, MD, Anette Lang-Dullenkopf, MD, Lukas Hegi, MD, Michael von Rhein, PD, MD, Vera Bernet, MD : Prof, Maren Tomaske, MD : Prof, Dirk Bassler, MD, MSc : Prof, Romaine Arlettaz, MD : Prof, Cornelia Hagmann, MD : Prof, Bea Latal, MD : Prof, Ruth Etter, MD

¹ Newborn Research, Department of Neonatology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
² Swiss Neonatal Network & Follow-up Group, Zurich, Switzerland
³ Department of Neonatology, University Children’s Hospital Basel (UKBB), Basel, Switzerland
⁴ Larsson-Rosenquist Centre for Neurodevelopment, Growth and Nutrition of the Newborn, University of Zurich and University Hospital Zurich, Zurich, Switzerland
⁵ Clinic of Neonatology, Department Woman-Mother-Child, University Hospital Lausanne, Lausanne, Switzerland
⁶ Paediatric and Neonatal Intensive Care Unit, Department of Paediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland
⁷ Department of Woman, Child and Adolescent, Geneva University Hospital, Geneva, Switzerland

^∗Reprint requests: Mark Adams, PhD, Newborn Research, Department of Neonatology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, SwitzerlandNewborn ResearchDepartment of NeonatologyUniversity Hospital ZurichFrauenklinikstrasse 10Zurich8091Switzerland

Abstract

Objective

To assess patent ductus arteriosus treatment variation between Swiss perinatal centers and to determine its effect on outcome in a population-based setting.

Study design

This was a retrospective cohort study of infants born less than 28 weeks of gestation between 2012 and 2017. Outcomes between surgically ligated and pharmacologically treated infants as well as infants born in centers performing ≤10% ligation (“low” group) and >10% (“high” group) were compared using logistic regression and 1:1 propensity score matching. Matching was based on case-mix and preligation confounders: intraventricular hemorrhages grades 3-4, necrotizing enterocolitis, sepsis, and ≥28 days’ oxygen supply.

Results

Of 1389 infants, 722 (52%) had pharmacologic treatment and 156 (11.2%) received surgical ligation. Compared with infants who received pharmacologic treatment, ligated infants had greater odds for major morbidities (OR 2.09, 95% CI 1.44-3.04) and 2-year neurodevelopmental impairment (OR 1.81, 95% CI 1.15-2.84). Mortality was comparable after restricting the cohort to infants surviving at least until day 10 to avoid survival bias. In the “low” group, 34 (4.9%) of 696 infants were ligated compared with 122 (17.6%) of 693 infants in the “high” group. Infants in the “high” group had greater odds for major morbidities (OR 1.49, 95% CI 1.11-2.0).

Conclusions

Our analysis identified a burden on infants receiving surgical ligation vs pharmacologic treatment in a population-based setting where there was no agreed-on common procedure. These results may guide a revision of patent ductus arteriosus treatment practice in Switzerland.

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Keywords : extremely preterm, patent ductus arteriosus ligation, mortality, morbidities, neurodevelopmental impairment

Abbreviations : BWZ, DOL, IVH, LOS, NDI, NEC, O₂, PDA, ROP

Plan

M.A. receives a salary as network coordinator for the Swiss Neonatal Network. The authors received no specific funding for this work. The other authors declare no conflicts of interest.

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P. 213 - octobre 2021 Retour au numéro

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Outcomes for Infants Born in Perinatal Centers Performing Fewer Surgical Ligations for Patent Ductus Arteriosus: A Swiss Population-Based Study - 22/09/21

Abstract

Objective

Study design

Results

Conclusions

Plan

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