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International Variation in the Management of Patent Ductus Arteriosus and Its Association with Infant Outcomes: A Survey and Linked Cohort Study - 06/05/22

Doi : 10.1016/j.jpeds.2021.12.071 
Tetsuya Isayama, MD, PhD 1, Satoshi Kusuda, MD, PhD 2, Mark Adams, PhD 3, Elettra Berti, MD 4, Malcolm Battin, MD 5, Kjell Helenius, PhD 6, 7, Stellan Håkansson, MD 8, Maximo Vento, PhD 9, Mikael Norman, MD, PhD 10, Brian Reichman, MBChB 11, Akihiko Noguchi, MD 12, Shoo K. Lee, MB 13, 14, Dirk Bassler, PhD 3, Kei Lui, MD 15, Liisa Lehtonen, PhD 6, 7, Junmin Yang, MSc 13, Prakesh S. Shah, MD 13, 14, ⁎
on behalf of the

International Network for Evaluating Outcomes of Neonates (iNeo) Investigators∗

  List of additional members of the iNeo is available at www.jpeds.com (Appendix).

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 
7 Department of Clinical Medicine, University of Turku, Turku, Finland 
8 Department of Clinical Science/Pediatrics, Umeå University, Umeå, Sweden 
9 Division of Neonatology, Health Research Institute La Fe, Valencia, Spain 
10 Department of Neonatal Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden 
11 Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel 
12 Illinois Neonatal Network, Saint Louis University, Saint Louis, IL 
13 Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada 
14 Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada 
15 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 

∗Reprint requests: Dr Prakesh S. Shah, MD, FRCPC, MSc, Department of Pediatrics, Mount Sinai Hospital, 600 University Ave, Room 19-231, Toronto, Ontario, Canada M5G 1X5Department of PediatricsMount Sinai Hospital600 University Ave, Room 19-231TorontoOntarioM5G 1X5Canada

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.

Le texte complet de cet article est disponible en PDF.

Keywords : patent ductus arteriosus, infants born preterm, echocardiography, questionnaire survey

Abbreviations : ILNN, iNeo, IVH, NICU, NRNJ, PDA, ROP


Plan


 Supported by the Canadian Institutes of Health Research [APR-126340 to P.S.]. The Australian and New Zealand Neonatal Network is predominantly funded by membership contributions from the participating centers. The Canadian Neonatal Network is supported by a team grant from the Canadian Institutes of Health Research [CTP 87518], by the Ontario Ministry of Health and Long-Term Care, and by the participating centers. The Finnish Medical Birth Register is governmentally funded and kept by the National Institute for Health and Welfare (THL). The Israel Neonatal Network very low birth weight infant database is partially funded by the Israel Center for Disease Control and the Ministry of Health. The Neonatal Research Network of Japan is partly funded by a Health Labour Sciences Research Grant from the Ministry of Health, Labour and Welfare of Japan. The Spanish Neonatal Network is supported by funds from the Spanish Neonatal Society (SENeo). The Swedish Neonatal Quality Register is funded by the Swedish Government (Ministry of Health and Social Affairs), the body of regional health care providers (County Councils), and the participating units. The Swiss Neonatal Network is partially funded by the participating units in the form of membership fees. The Tuscany Neonatal Network is funded by the Tuscany Region. This research was also supported by Instituto de Investigación Sanitaria Carlos III (Ministry of Science, Innovation and Universities, Kingdom of Spain) [FIS17/0131 to M.V.]; and RETICS funded by the PN 2018-2021 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion, and the European Regional Development Fund (ERDF) [RD16/0022]; and by grants from a regional agreement on clinical research (ALF) between Region Stockholm and Karolinska Institutet [2020-0443 to M.N.]. The funding bodies played no role in the design or conduct of the study; the collection, management, analysis, or interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. The authors declare no conflicts of interest.


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Vol 244

P. 24 - mai 2022 Retour au numéro
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