title: Association Between Early Screening for Patent Ductus Arteriosus and In-Hospital Mortality Among Extremely Preterm Infants.
abstract: OBJECTIVE
  There is currently no consensus for the screening and treatment of patent ductus arteriosus (PDA) in extremely preterm infants. Less pharmacological closure and more supportive management have been observed without evidence to support these changes.
  
  
  OBJECTIVE
  To evaluate the association between early screening echocardiography for PDA and in-hospital mortality.
  
  
  METHODS
  Comparison of screened and not screened preterm infants enrolled in the EPIPAGE 2 national prospective population-based cohort study that included all preterm infants born at less than 29 weeks of gestation and hospitalized in 68 neonatal intensive care units in France from April through December 2011. Two main analyses were performed to adjust for potential selection bias, one using propensity score matching and one using neonatal unit preference for early screening echocardiography as an instrumental variable.
  
  
  METHODS
  Early screening echocardiography before day 3 of life.
  
  
  METHODS
  The primary outcome was death between day 3 and discharge. The secondary outcomes were major neonatal morbidities (pulmonary hemorrhage, severe bronchopulmonary dysplasia, severe cerebral lesions, and necrotizing enterocolitis).
  
  
  RESULTS
  Among the 1513 preterm infants with data available to determine exposure, 847 were screened for PDA and 666 were not; 605 infants from each group could be paired. Exposed infants were treated for PDA more frequently during their hospitalization than nonexposed infants (55.1% vs 43.1%; odds ratio [OR], 1.62 [95% CI, 1.31 to 2.00]; absolute risk reduction [ARR] in events per 100 infants, -12.0 [95% CI, -17.3 to -6.7). Exposed infants had a lower hospital death rate (14.2% vs 18.5% ; OR, 0.73 [95% CI, 0.54 to 0.98]; ARR, 4.3 [95% CI, 0.3 to 8.3]) and a lower rate of pulmonary hemorrhage (5.6% vs 8.9%; OR, 0.60 [95% CI, 0.38 to 0.95]; ARR, 3.3 [95% CI, 0.4 to 6.3]). No differences in rates of necrotizing enterocolitis, severe bronchopulmonary dysplasia, or severe cerebral lesions were observed. In the overall cohort, instrumental variable analysis yielded an adjusted OR for in-hospital mortality of 0.62 [95% CI, 0.37 to 1.04].
  
  
  CONCLUSIONS
  In this national population-based cohort of extremely preterm infants, screening echocardiography before day 3 of life was associated with lower in-hospital mortality and likelihood of pulmonary hemorrhage but not with differences in necrotizing enterocolitis, severe bronchopulmonary dysplasia, or severe cerebral lesions. However, results of the instrumental variable analysis leave some ambiguity in the interpretation, and longer-term evaluation is needed to provide clarity.
authors.affiliation: Department of Neonatal Medicine, Nantes University Hospital, Nantes, France2Epidémiologie Clinique, Centre d'Investigation Clinique (CIC004), Nantes University Hospital, Nantes, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Rozé
authors.affiliation: Montpellier Department of Neonatal Medicine, Montpellier University Hospital, Montpellier.
authors.forename: Gilles
authors.initials: G
authors.lastname: Cambonie
authors.affiliation: INSERM, U1153, Obstetrical, Perinatal and Pediatric Epidemiology Team, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Paris Descartes University, France.
authors.forename: Laetitia
authors.initials: L
authors.lastname: Marchand-Martin
authors.affiliation: Pediatric Cardiology Unit, Nantes University Hospital, Nantes, France.
authors.forename: Veronique
authors.initials: V
authors.lastname: Gournay
authors.affiliation: INSERM, U1153, Obstetrical, Perinatal and Pediatric Epidemiology Team, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Paris Descartes University, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Durrmeyer
authors.affiliation: INSERM, U1153, Obstetrical, Perinatal and Pediatric Epidemiology Team, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Paris Descartes University, France.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Durox
authors.affiliation: Department of Neonatal Medicine, Lille University Hospital, Lille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Storme
authors.affiliation: INSERM, U1153, METHODS Team, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Paris Descartes University, France.
authors.forename: Raphael
authors.initials: R
authors.lastname: Porcher
authors.affiliation: INSERM, U1153, Obstetrical, Perinatal and Pediatric Epidemiology Team, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Paris Descartes University, France8Centre d'Investivation Clinique (CIC P1419), Cochin Hotel-Dieu Hospital, Assistance.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Ancel
mesh_terms: D001921:Brain / Q000473:pathology; D015331:Cohort Studies; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging* / Q000401:mortality; D004452:Echocardiography; D020345:Enterocolitis, Necrotizing / Q000517:prevention & control; D005260:Female; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging* / Q000401:mortality / Q000517:prevention & control; D016015:Logistic Models; D008171:Lung Diseases / Q000517:prevention & control; D008297:Male; D008403:Mass Screening; D057216:Propensity Score