Trends in transcatheter and operative closure of patent ductus arteriosus in neonatal intensive care units: Analysis of data from the Pediatric Health Information Systems Database - 15/11/19
, Marisa E. Millenson, MS b, Connor B. Grady, BS a, Jing Huang, PhD a, d, Nicolas A. Bamat, MD MSCE b, e, David A. Munson, MD e, Lihai Song, MS b, Yoav Dori, MD PhD a, Matthew J. Gillespie, MD a, Jonathan J. Rome, MD a, Andrew C. Glatz, MD MSCE a, bAbstract |
Background |
The risks and benefits of pharmacologic treatment and operative closure of patent ductus arteriosus (O-PDA) in premature infants remain controversial. Recent series have demonstrated the feasibility of transcatheter PDA closure (TC-PDA) in increasingly small infants. The effect of this change on practice has not been evaluated.
Methods |
A multicenter observational study of infants treated in neonatal intensive care units in hospitals contributing data to the Pediatric Health Information Systems Database from January 2007 to December 2017 was performed to study trends in the propensities for (1) mechanical closure of PDA and (2) TC-PDA versus O-PDA, as well as interhospital variation in practice.
Results |
A total of 6,214 subjects at 44 hospitals were studied (5% TC-PDA). Subject median gestational age was 25 weeks (interquartile range: 24-27 weeks). Median age at closure was 24 days (interquartile range: 14-36 days). The proportion of all neonatal intensive care unit patients undergoing either O-PDA or TC-PDA decreased (3.1% in 2007 and 0.7% in 2017, P < .001), whereas the proportion in which TC-PDA was used increased significantly (0.1% in 2007 to 29.0% in 2017). Case-mix–adjusted multivariable models similarly demonstrated increasing propensity to pursue TC-PDA (odds ratio [OR] 1.66 per year, P < .001) with acceleration of the trend after 2014 (OR 2.46 per year, P < .001) as well as significant practice variation (P < .001, median OR 4.6) across the study period.
Conclusions |
In the face of decreasing closure of PDA, the use of TC-PDA increased dramatically with significant practice variability. This demonstrates that there is equipoise for potential clinical trials.
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| Funding sources: Dr O'Byrne receives support from the National Institute of Health/National Heart Lung and Blood Institute (K23 HL130420-01). Mr Grady received support from The Children's Hospital of Philadelphia Research Institute Summer Scholars Program program. The funding agencies had no role in the planning or execution of the study, nor did they edit the manuscript as presented. The manuscript represents the opinions of the authors alone. |
Vol 217
P. 121-130 - Novembre 2019 Ritorno al numero
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