title: Nonsteroidal anti-inflammatory administration and patent ductus arteriosus ligation, a survey of practice preferences at US children's hospitals.
abstract: We surveyed neonatal leadership at 46 US children's hospitals via web-based survey to identify local preferences and concerns regarding indomethacin prophylaxis, nonsteroidal anti-inflammatory drug (NSAID) treatment, and patent ductus arteriosus (PDA) ligation. We received a 100 % survey response (N = 46). Practice guidelines for prophylactic indomethacin were reported at 28 % of NICUs, for NSAID treatment of PDA at 39 % and for surgical ligation at 27 %. Respondents noted intra-institutional practice variation for indomethacin prophylaxis (33 %), NSAID treatment (70 %), and PDA ligation (73 %). The majority of institutions did not prescribe indomethacin prophylaxis (72 %). For PDA treatment, indomethacin was preferred over ibuprofen (80 %). We validated our survey results via comparison with billing data as documented in the Pediatric Health Information System (PHIS) database, finding that survey responses directly correlated with local billing data (p < 0.0001). At institutions that did not typically administer NSAIDs for PDA closure or surgical PDA ligation, a lack of evidence for their effectiveness in improving long-term outcomes and the risk of treatment-associated adverse effects were the most often cited reasons.
  
  
  CONCLUSIONS
  No consensus exists among providers at US children's hospitals regarding prophylactic indomethacin, NSAID treatment, or PDA ligation. Lack of evidence and safety concerns play a prominent role.
  
  
  BACKGROUND
  • NSAIDs and surgical PDA ligation are efficacious in preventing intraventricular hemorrhage (IVH) and closing PDA in preterm infants, but have not been shown to improve long-term respiratory, neurodevelopmental, or mortality outcomes. What is New: • Practice preferences for indomethacin prophylaxis, NSAID, and surgical PDA treatment vary both among and within institutions. Lack of treatment effectiveness and the risk of adverse effects are major concerns.
authors.affiliation: Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA. Slaughter.84@osu.edu.|Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH, USA. Slaughter.84@osu.edu.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Slaughter
authors.affiliation: Department of Economics and Center for Human Resource Research, The Ohio State University, Columbus, OH, USA.
authors.forename: Patricia B
authors.initials: PB
authors.lastname: Reagan
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Roopali V
authors.initials: RV
authors.lastname: Bapat
authors.affiliation: Departments of Epidemiology and Biostatistics and Pediatrics, University of California, San Francisco, CA, USA.
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Newman
authors.affiliation: Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.|Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Klebanoff
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D032921:Consensus; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D004374:Ductus Arteriosus, Patent / Q000628:therapy*; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use*; D007213:Indomethacin / Q000627:therapeutic use*; D007231:Infant, Newborn; D008026:Ligation; D009359:Neonatology / Q000458:organization & administration; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D007052:Ibuprofen; D007213:Indomethacin
keywords: Drug utilization; Ibuprofen; Indomethacin; Intraventricular hemorrhage; Nonsteroidal anti-inflammatory drugs; Patent ductus arteriosus; Pharmacoepidemiology; Practice preference; Practice survey; Practice variation; Prematurity