title: Changing Management of the Patent Ductus Arteriosus: Effect on Neonatal Outcomes and Resource Utilization.
abstract: ObjectiveThis historical cohort study investigated how a shift toward a more conservative approach of awaiting spontaneous closure of the patent ductus arteriosus (PDA) in preterm infants has affected neonatal outcomes and resource utilization.MethodsWe retrospectively studied very low birth weight infants diagnosed with a PDA by echocardiogram (ECHO) in 2006-2008 (era 1), when medical or surgical PDA management was emphasized, to those born in 2010-2012 (era 2) when conservative PDA management was encouraged. Multiple regression analyses adjusted for gestational age were performed to assess differences in clinical outcomes and resource utilization between eras.ResultsMore infants in era 2 (35/89, 39%) compared with era 1 (22/120, 18%) had conservative PDA management (p< 0.01). Despite no difference in surgical ligation rate, infants in era 2 had ligation later (median 24 vs. 8 days,p< 0.0001). There was no difference in clinical outcomes between eras, while number of ECHOs per patient was the only resource measure that increased in era 2 (median 3 vs. 2 ECHOs,p= 0.003).ConclusionIn an era of more conservative PDA management, no increase in adverse clinical outcomes or significant change in resource utilization was found. Conservative PDA management may be a safe alternative for preterm infants.
authors.affiliation: Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Valerie Y
authors.initials: VY
authors.lastname: Chock
authors.affiliation: Pediatric Hospital Medicine, Stanford University School of Medicine, Palo Alto, California.|Clinical Informatics, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Veena V
authors.initials: VV
authors.lastname: Goel
authors.affiliation: Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California.|Clinical Informatics, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Palma
authors.affiliation: Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Luh
authors.affiliation: Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Nichole A
authors.initials: NA
authors.lastname: Wang
authors.affiliation: Pediatric Pharmacy, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Shabnam
authors.initials: S
authors.lastname: Gaskari
authors.affiliation: Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Punn
authors.affiliation: Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Norman H
authors.initials: NH
authors.lastname: Silverman
authors.affiliation: Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California.
authors.forename: William E
authors.initials: WE
authors.lastname: Benitz
mesh_terms: D001724:Birth Weight; D002317:Cardiovascular Agents / Q000627:therapeutic use; D000072700:Conservative Treatment; D019468:Disease Management; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D004452:Echocardiography; D005260:Female; D005865:Gestational Age; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008026:Ligation; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D057832:Watchful Waiting
chemical_list: D002317:Cardiovascular Agents; D007213:Indomethacin