title: Prevalence and management of patent ductus arteriosus in a pediatric medicaid cohort.
abstract: BACKGROUND
  Widespread use of echocardiography has made earlier diagnosis of patent ductus arteriosus (PDA) possible, but pharmacological or surgical intervention is highly variable. Herein, we investigate the prevalence of PDA and its management in a routine care system.
  
  
  METHODS
  A 15-year retrospective dataset (1996-2010) was analyzed. Selection criteria included age ≤17 years, enrollees in South Carolina State Medicaid, and diagnosed as having PDA on 1 or more service visits to a pediatrician or pediatric cardiologist.
  
  
  RESULTS
  The 15-year treated prevalence rate of PDA was 0.25/1000 pediatric cases of congenital heart disease (CHD). PDA was more prevalent in non-African American patients (adjusted odds ratio [aOR]: 1.12), but not in females after controlling for all other CHDs diagnosed in the cohort. Associated CHDs were present in 57.6% of the cases, primarily atrial or ventricular septal defects, and fewer patients (5.5%) developed pulmonary hypertension. Of 3627 PDA cases examined, 70.0% received no medications or PDA repair. Therapeutic ibuprofen was used for closure in 24.4% of the cases, and a PDA repair was performed in 7.8%. Younger children (aOR: 0.82), those who received an atrial septal defect closure (aOR: 5.18), and those who were treated with digoxin (aOR: 1.86) or with diuretics or preload/afterload reducing agents (ie, calcium channel blockers or angiotensin-converting enzyme inhibitors) (aOR: 5.72) were significantly more likely to have a PDA repair procedure.
  
  
  CONCLUSIONS
  The majority of diagnosed PDA cases did not require pharmacological or surgical intervention. Those receiving pharmacological or surgical intervention were treated conservatively in relation to the presence of distress symptoms or concomitant CHDs requiring intervention.
authors.affiliation: Department Medicine, University of Mississippi School of Medicine, Jackson, Mississippi.
authors.forename: Avnish
authors.initials: A
authors.lastname: Tripathi
authors.forename: George B
authors.initials: GB
authors.lastname: Black
authors.forename: Yong-Moon Mark
authors.initials: YM
authors.lastname: Park
authors.forename: Jeanette M
authors.initials: JM
authors.lastname: Jerrell
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000379:methods*; D004374:Ductus Arteriosus, Patent / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D008484:Medicaid; D015995:Prevalence; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007052:Ibuprofen