title: Using benchmarking to identify inter-centre differences in persistent ductus arteriosus treatment: can we improve outcome?
abstract: OBJECTIVE
  The aim of this study was to identify inter-centre differences in persistent ductus arteriosus treatment and their related outcomes. Materials and methods We carried out a retrospective, multicentre study including infants between 24+0 and 27+6 weeks of gestation in the period between 2010 and 2011. In all centres, echocardiography was used as the standard procedure to diagnose a patent ductus arteriosus and to document ductal closure.
  
  
  RESULTS
  In total, 367 preterm infants were included. All four participating neonatal ICU had a comparable number of preterm infants; however, differences were observed in the incidence of treatment (33-63%), choice and dosing of medication (ibuprofen or indomethacin), number of pharmacological courses (1-4), and the need for surgical ligation after failure of pharmacological treatment (8-52%). Despite the differences in treatment, we found no difference in short-term morbidity between the centres. Adjusted mortality showed independent risk contribution of gestational age, birth weight, ductal ligation, and perinatal centre.
  
  
  CONCLUSIONS
  Using benchmarking as a tool identified inter-centre differences. In these four perinatal centres, the factors that explained the differences in patent ductus arteriosus treatment are quite complex. Timing, choice of medication, and dosing are probably important determinants for successful patent ductus arteriosus closure.
authors.affiliation: 1Department of Neonatology,Máxima Medical Centre,Veldhoven,The Netherlands.
authors.forename: Esther J S
authors.initials: EJS
authors.lastname: Jansen
authors.affiliation: 1Department of Neonatology,Máxima Medical Centre,Veldhoven,The Netherlands.
authors.forename: Koen P
authors.initials: KP
authors.lastname: Dijkman
authors.affiliation: 2Department of Neonatology,Amalia Children's Centre Isala,Zwolle,The Netherlands.
authors.forename: Richard A
authors.initials: RA
authors.lastname: van Lingen
authors.affiliation: 3Department of Neonatology,University Medical Centre Utrecht,Utrecht,The Netherlands.
authors.forename: Willem B
authors.initials: WB
authors.lastname: de Vries
authors.affiliation: 3Department of Neonatology,University Medical Centre Utrecht,Utrecht,The Netherlands.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Vijlbrief
authors.affiliation: 4Department of Neonatology,Radboudumc,Nijmegen,The Netherlands.
authors.forename: Willem P
authors.initials: WP
authors.lastname: de Boode
authors.affiliation: 1Department of Neonatology,Máxima Medical Centre,Veldhoven,The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Andriessen
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D019985:Benchmarking / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000592:standards / Q000639:trends*; D004374:Ductus Arteriosus, Patent / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use*; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008026:Ligation; D008297:Male; D009017:Morbidity / Q000639:trends; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007052:Ibuprofen
keywords: Patent ductus arteriosus; ductal ligation; ibuprofen; indomethacin; newborn; patent ductus arteriosus