222 - Secular Trends in Patent Ductus Arteriosus Management in Preterm Infants within the Neonatal Research Network

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 222
Publication Number: 222.329

Dinushan C. Kaluarachchi, University of Wisconsin - Madison, Madison, WI, United States; Matthew Rysavy, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Benjamin A. Carper, RTI International, RTP, NC, United States; Valerie Y. Chock, Stanford University School of Medicine, Sunnyvale, CA, United States; Matthew Laughon, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Carl Backes, Nationwide Children's Hospital, Columbus, OH, United States; Tarah T. Colaizy, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States; Edward F.. Bell, University of Iowa, Iowa City, IA, United States; Patrick J. McNamara, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, United States; NICHD Neonatal Research Network, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States

Presenting Author(s)

Dinushan C. Kaluarachchi, MBBS (he/him/his)

Associate Professor
University of Wisconsin - Madison
Madison, Wisconsin, United States

Background: The optimal approach to diagnosis and management of clinically significant patent ductus arteriosus (PDA) in preterm infants has been a focus of substantial research during the past decade but remains controversial.

Objective: To evaluate changes in PDA diagnosis and treatment 2012-2021 in a network of U.S. academic hospitals.

Design/Methods:

The study included data for all infants born at gestational ages 22 0/7 to 28 6/7 weeks from 2012 to 2021 in 23 continually participating hospitals in the NICHD Neonatal Research Network. PDA diagnosis was defined as any clinical documentation of clinical or echocardiographic evidence of left-to-right PDA physiology. Medical PDA treatments were documented as “yes” for any drug treatment regardless of timing, duration, or dose. Procedural PDA treatment included catheter and transthoracic surgical closure. Rates of diagnosis and treatment were compared using the Cochran-Armitage trend test to evaluate time-related changes in proportions. Additional analyses were completed for gestational age-specific temporal trends and to assess hospital variation in diagnosis and management.

Results: The study included 12,982 infants. Mean gestational age and birth weight were 26.3 weeks and 855 g, respectively. For the entire cohort, there was an increase in PDA diagnosis (43.8% to 45.8%) from 2012 to 2021, yet a decrease in medical treatment or procedural closure (28.0% to 24.3%) (Table 1). The decrease in PDA treatment appeared isolated to more mature infants (26 0/7 to 28 6/7 weeks: 19.6% to 15.1% vs 22 0/7 to 25 6/7 weeks 41.6% to 41.0% [Table 2). The approach to treatment also changed: indomethacin use and PDA ligation decreased, while acetaminophen use and transcatheter PDA closure increased during the study period (Table 3). There was substantial variability in PDA diagnosis and treatment among participating hospitals.

Conclusion(s): In a large cohort of extremely preterm infants born at academic centers in the United States, medical treatment or procedural closure of PDAs decreased among infants born at 26 0/7 to 28 6/7 weeks but not among infants born at 22 0/7 to 25 6/7 weeks. Treatment with acetaminophen and transcatheter PDA closure became more common during this time period. The impact of these secular changes on mortality and neonatal morbidity require investigation.