title: Hospital variation in medical and surgical treatment of patent ductus arteriosus.
abstract: OBJECTIVE
  This study aims to characterize population risks for diagnosis, medical treatment, and surgical ligation of patent ductus arteriosus (PDA) in very low-birth-weight infants.
  
  
  METHODS
  Maternal and neonatal data were collected in 40 hospitals in California during 2011 for infants with birth weight ≤ 1,500 g without any congenital malformation, with a diagnosis of PDA. Multivariable logistic regression was used to determine independent risks for PDA diagnosis and for surgical ligation.
  
  
  RESULTS
  There were 770/1,902 (40.4%) infants diagnosed with PDA. Low birth weight, gestational age, respiratory distress syndrome, and surfactant administration were associated with PDA diagnosis. Ligation occurred in 43% of patients with birth weight ≤ 750 g, in 24% of patients weighing between 715 and 1,000 g, and in 12% of patients weighing from 1,001 to 1,500 g. Older gestational age (1 week, odds ratio 0.55, 95% confidence interval 0.48-0.63) and absence of respiratory distress syndrome (odds ratio 0.14, 95% confidence interval 0.03-0.59) were associated with lower ligation risk. The median hospital ligation rate was 14% (interquartile range 0-38%).
  
  
  CONCLUSIONS
  Most patients with PDA receive treatment for closure. Practice variation may set the stage for further exploration of experimental trials.
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Palo Alto, California.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Lee
authors.affiliation: Division of Neonatology, Department of Pediatrics, Children's Hospital and Research Center, Oakland, California.
authors.forename: David J
authors.initials: DJ
authors.lastname: Durand
authors.affiliation: Health Information Solutions, Roseville, California.
authors.forename: Beate
authors.initials: B
authors.lastname: Danielsen
authors.affiliation: California Perinatal Quality Care Collaborative, Palo Alto, California.
authors.forename: Grace Villarin
authors.initials: GV
authors.lastname: Dueñas
authors.affiliation: Division of Neonatology, Department of Pediatrics, Good Samaritan Hospital, San Jose, California.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Powers
mesh_terms: D001724:Birth Weight; D002140:California; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D004374:Ductus Arteriosus, Patent / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005865:Gestational Age; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use; D007213:Indomethacin / Q000627:therapeutic use; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008026:Ligation; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications; D012307:Risk Factors
chemical_list: D016861:Cyclooxygenase Inhibitors; D007052:Ibuprofen; D007213:Indomethacin