title: Trends and Outcomes of Patent Ductus Arteriosus Treatment in Very Preterm Infants in Canada.
abstract: ObjectiveTo assess trends in patent ductus arteriosus (PDA) management and examine concurrent changes in neonatal mortality and morbidities.MethodsThis retrospective observational study examined infants born at 23 to 32 weeks' gestational age with PDA and admitted to a neonatal unit during 2006 to 2012. Multivariable logistic regression assessed trends in yearly PDA treatment rates and compared a composite outcome of mortality or any severe morbidity (bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity, or necrotizing enterocolitis) between and within time periods and PDA treatments.ResultsStudy subjects included 5,824 preterm neonates with clinical/echocardiographic PDA diagnosis. During 2006 to 2012, conservative management increased (14-38%), whereas pharmacotherapy-only (58-49%), surgical ligation-only (7.1-2.5%), and both pharmacotherapy and surgical ligation (21-10%) decreased (p-values <0.01). From 2006 to 2008 and 2009 to 2012, the composite outcome decreased for infants managed conservatively (AOR = 0.70, 95% CI 0.52-0.92), with no changes detected for pharmacotherapy and/or ligation. Lower composite outcome after conservative management versus pharmacotherapy-only during 2009 to 2012 (AOR = 0.61, 95% CI 0.51-0.74), but not during 2006 to 2008 reflect significant effect modification by time period.ConclusionIn Canada, during 2006 to 2012, conservative PDA management increased while pharmacotherapy and/or surgical ligation decreased. Lower composite outcome was detected during later years after increases in conservative management; however, bias due to unmeasured confounders remains possible.
authors.affiliation: Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Armend
authors.initials: A
authors.lastname: Lokku
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lucia
authors.initials: L
authors.lastname: Mirea
authors.affiliation: Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Shoo K
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Prakeshkumar S
authors.initials: PS
authors.lastname: Shah
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D000074042:Cerebral Intraventricular Hemorrhage / Q000453:epidemiology; D000072700:Conservative Treatment / Q000639:trends; D004358:Drug Therapy / Q000639:trends; D004374:Ductus Arteriosus, Patent / Q000401:mortality* / Q000628:therapy*; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007969:Leukomalacia, Periventricular / Q000453:epidemiology; D008026:Ligation / Q000639:trends; D008297:Male; D047928:Premature Birth / Q000453:epidemiology*; D012178:Retinopathy of Prematurity / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome