title: Trends and variation in management and outcomes of very low-birth-weight infants with patent ductus arteriosus.
abstract: We examined recent trends and interhospital variation in use of indomethacin, ibuprofen, and surgical ligation for patent ductus arteriosus (PDA) in very-low-birth-weight (VLBW) infants.
  
  
  
  Included in this retrospective study of the Pediatric Hospital Information System database were 13,853 VLBW infants from 19 US children's hospitals, admitted at age < 3 d between 1 January 2005 and 31 December 2014. PDA management and in-hospital outcomes were examined for trends and variation.
  
  
  
  PDA was diagnosed in 5,719 (42%) VLBW infants. Cyclooxygenase inhibitors and/or ligation were used in 74% of infants with PDA overall, however studied hospitals varied greatly in PDA management. Odds of any cyclooxygenase inhibitor or surgical treatment for PDA decreased 11% per year during the study period. This was temporally associated with improved survival but also with increasing bronchopulmonary dysplasia, periventricular leukomalacia, retinopathy of prematurity, and acute renal failure in unadjusted analyses. There was no detectable correlation between hospital-specific changes in PDA management and hospital-specific changes in outcomes of preterm birth during the study period.
  
  
  
  Use of cyclooxygenase inhibitors and ligation for PDA in VLBW infants decreased over a 10-y period at the studied hospitals. Further evidence is needed to assess the impact of this change in PDA management.
authors: Division of Neonatology, Connecticut Children's Medical Center, Hartford, Connecticut.|Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut.
authors: James I
authors: JI
authors: Hagadorn
authors: Division of Neonatology, Connecticut Children's Medical Center, Hartford, Connecticut.|Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut.
authors: Elizabeth A
authors: EA
authors: Brownell
authors: Division of Neonatology, Connecticut Children's Medical Center, Hartford, Connecticut.|Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut.
authors: Jennifer M
authors: JM
authors: Trzaski
authors: Division of Neonatology, Connecticut Children's Medical Center, Hartford, Connecticut.|Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut.
authors: Kendall R
authors: KR
authors: Johnson
authors: Division of Neonatology, Connecticut Children's Medical Center, Hartford, Connecticut.|Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut.
authors: Shabnam
authors: S
authors: Lainwala
authors: Department of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, Connecticut.
authors: Brendan T
authors: BT
authors: Campbell
authors: Divisions of Pediatric Urology and Nephrology, and Department of Research, Connecticut Children's Medical Center, Hartford, Connecticut.
authors: Katherine W
authors: KW
authors: Herbst
mesh_terms: D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D016208:Databases, Factual; D004374:Ductus Arteriosus, Patent / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use; D007213:Indomethacin / Q000627:therapeutic use; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008026:Ligation; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States
chemical_list: D016861:Cyclooxygenase Inhibitors; D007052:Ibuprofen; D007213:Indomethacin