Variation in the diagnosis and management of patent ductus arteriosus in premature infants.
OBJECTIVE
To determine variations in neonatology practice regarding the diagnosis and management of patent ductus arteriosus (PDA) in premature infants.


METHODS
Standardized telephone interview of preferences and practices.


METHODS
Canadian neonatologists in active clinical practice.


RESULTS
Of 136 eligible Canadian neonatologists, 100 respondents (74%) estimated the proportion of infants with suspected PDA who have echocardiography to be a median of 80% (range 0% to 100%), with considerable variation both within and between centres. Only two centres had written guidelines. More recent medical school graduates were significantly more likely to use echocardiography. Increased use of echocardiography was also significantly related to increased availability. Fluid restriction and indomethacin was used as initial therapy by 89% of respondents, with the indomethacin dose standardized for 83%; surgical ligation was used when indomethacin therapy was contraindicated or had failed. Personal guidelines directed decisions regarding therapy for the majority of neonatologists.


CONCLUSIONS
Among Canadian neonatologists, there is considerable variation regarding practices related to the diagnosis and management of PDA in premature infants. This variation may potentially affect the cost effectiveness of care for these patients.
Lai
L S
LS
Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario.
McCrindle
B W
BW
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