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Association between early echocardiography, therapy for patent ductus arteriosus, and outcomes in very low birth weight infants

  • Jan Hau Lee (a1) (a2), Rachel G. Greenberg (a3) (a4), Bin H. Quek (a2) (a5), Reese H. Clark (a6), Matthew M. Laughon (a7), P. Brian Smith (a3) (a4) and Christoph P. Hornik (a3) (a4)...

Abstract

Background

In very low birth weight infants, persistence of a patent ductus arteriosus results in morbidity and mortality. Therapies to close the ductus are effective, but clinical outcomes may depend on the accuracy of diagnosis and the timing of administration. The objective of the present study was to characterise the association between early echocardiography, therapy for patent ductus arteriosus, and outcomes in very low birth weight infants.

Methods

This retrospective cohort study used electronic health record data on inborn infants of gestational age ⩽28 weeks and birth weight <1500 g who were discharged after day of life 7 from 362 neonatal ICU from 1997 to 2013. The primary outcome was death between day of life 7 and discharge. Secondary outcomes included bronchopulmonary dysplasia, necrotising enterocolitis, and grade 3 or 4 intraventricular haemorrhage.

Results

This study included a total of 48,551 infants with a median gestational age of 27 weeks (interquartile range 25, 28) and birth weight 870 g (706, 1050). Early echocardiography – that is, performed during days of life 2 to 6 – was performed in 15,971/48,551 (33%) infants, and patent ductus arteriosus was diagnosed in 31,712/48,551 (65%). The diagnosis was more common in infants who had undergone early echocardiography (14,549/15,971 [91%] versus 17,163/32,580 [53%], p<0.001). In multivariable analysis, early echocardiography was not associated with reduced mortality (odds ratio 0.97, 95% CI 0.89–1.05). Results were similar in the subset of infants who received therapy for patent ductus arteriosus (odds ratio 1.01, 95% CI 0.90–1.15).

Conclusions

Early echocardiography was associated with an increased diagnosis of patent ductus arteriosus, but not with decreased mortality.

Copyright

Corresponding author

Correspondence to: C. P. Hornik, MD, MPH, Duke Clinical Research Institute, Duke University School of Medicine, Box 17969, Durham, NC 27715, United States of America. Tel: +919 668 8935; Fax: +919 668 7058; E-mail: christoph.hornik@duke.edu

References

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1. Noori, S, McCoy, M, Friedlich, P, et al. Failure of ductus arteriosus closure is associated with increased mortality in preterm infants. Pediatrics 2009; 123: e138e144.
2. Benitz, WE. Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis? J Perinatol 2010; 30: 241252.
3. Sellmer, A, Bjerre, JV, Schmidt, MR, et al. Morbidity and mortality in preterm neonates with patent ductus arteriosus on day 3. Arch Dis Child Fetal Neonatal Ed 2013; 98: F505F510.
4. Benitz, WE. Patent ductus arteriosus in preterm infants. Pediatrics 2016; 137: 16.
5. Gournay, V, Roze, JC, Kuster, A, et al. Prophylactic ibuprofen versus placebo in very premature infants: a randomised, double-blind, placebo-controlled trial. Lancet 2004; 364: 19391944.
6. Gudmundsdottir, A, Johansson, S, Hakansson, S, Norman, M, Kallen, K, Bonamy, AK. Timing of pharmacological treatment for patent ductus arteriosus and risk of secondary surgery, death or bronchopulmonary dysplasia: a population-based cohort study of extremely preterm infants. Neonatology 2015; 107: 8792.
7. Baylen, BG, Meyer, RA, Kaplan, S, Ringenburg, WE, Korfhagen, J. The critically ill premature infant with patent ductus arteriosus and pulmonary disease-an echocardiographic assessment. J Pediatr 1975; 86: 423432.
8. DeMauro, SB, Cohen, MS, Ratcliffe, SJ, Abbasi, S, Schmidt, B. Serial echocardiography in very preterm infants: a pilot randomized trial. Acta Paediatr 2013; 102: 10481053.
9. Van Overmeire, B, Van de Broek, H, Van Laer, P, Weyler, J, Vanhaesebrouck, P. Early versus late indomethacin treatment for patent ductus arteriosus in premature infants with respiratory distress syndrome. J Pediatr 2001; 138: 205211.
10. Roze, JC, Cambonie, G, Marchand-Martin, L, et al. Association between early screening for patent ductus arteriosus and in-hospital mortality among extremely preterm infants. JAMA 2015; 313: 24412448.
11. Spitzer, AR, Ellsbury, DL, Handler, D, Clark, RH. The Pediatrix BabySteps Data Warehouse and the Pediatrix QualitySteps improvement project system – tools for “meaningful use” in continuous quality improvement. Clin Perinatol 2010; 37: 4970.
12. Trembath, A, Hornik, CP, Clark, R, Smith, PB, Daniels, J, Laughon, M. Comparative effectiveness of surfactant preparations in premature infants. J Pediatr 2013; 163: 955960.e1.
13. Kliegman, RM, Walsh, MC. Neonatal necrotizing enterocolitis: pathogenesis, classification, and spectrum of illness. Curr Probl Pediatr 1987; 17: 213288.
14. Hamrick, SE, Hansmann, G. Patent ductus arteriosus of the preterm infant. Pediatrics 2010; 125: 10201030.
15. Jones, LJ, Craven, PD, Attia, J, Thakkinstian, A, Wright, I. Network meta-analysis of indomethacin versus ibuprofen versus placebo for PDA in preterm infants. Arch Dis Child Fetal Neonatal Ed 2011; 96: F45F52.
16. Gudmundsdottir, A, Johansson, S, Hakansson, S, Norman, M, Kallen, K, Bonamy, AK. The importance of echocardiography and an individual approach to patent ductus arteriosus treatment in extremely preterm infants. Neonatology 2015; 107: 257.
17. Kluckow, M, Evans, N. Early echocardiographic prediction of symptomatic patent ductus arteriosus in preterm infants undergoing mechanical ventilation. J Pediatr 1995; 127: 774779.
18. Alagarsamy, S, Chhabra, M, Gudavalli, M, Nadroo, AM, Sutija, VG, Yugrakh, D. Comparison of clinical criteria with echocardiographic findings in diagnosing PDA in preterm infants. J Perinat Med 2005; 33: 161164.
19. McNamara, PJ, Sehgal, A. Towards rational management of the patent ductus arteriosus: the need for disease staging. Arch Dis Child Fetal Neonatal Ed 2007; 92: F424F427.
20. El-Khuffash, AF, Slevin, M, McNamara, PJ, Molloy, EJ. Troponin T, N-terminal pro natriuretic peptide and a patent ductus arteriosus scoring system predict death before discharge or neurodevelopmental outcome at 2 years in preterm infants. Arch Dis Child Fetal Neonatal Ed 2011; 96: F133F137.
21. Kadivar, M, Kiani, A, Kocharian, A, Shabanian, R, Nasehi, L, Ghajarzadeh, M. Echocardiography and management of sick neonates in the intensive care unit. Congenit Heart Dis 2008; 3: 325329.
22. Schachinger, S, Stansfield, RB, Ensing, G, Schumacher, R. The prevalence of and attitudes toward neonatal functional echocardiography use and training in the United States: a survey of neonatal intensive care unit medical directors. J Neonatal Perinatal Med 2014; 7: 125130.
23. de Waal, K, Kluckow, M. Functional echocardiography; from physiology to treatment. Early Hum Dev 2010; 86: 149154.
24. Shah, DM, Kluckow, M. Early functional echocardiogram and inhaled nitric oxide: usefulness in managing neonates born following extreme preterm premature rupture of membranes (PPROM). J Paediatr Child Health 2011; 47: 340345.
25. Christmann, V, Liem, KD, Semmekrot, BA, van de Bor, M. Changes in cerebral, renal and mesenteric blood flow velocity during continuous and bolus infusion of indomethacin. Acta Paediatr 2002; 91: 440446.
26. Mirea, L, Sankaran, K, Seshia, M, et al. Treatment of patent ductus arteriosus and neonatal mortality/morbidities: adjustment for treatment selection bias. J Pediatr 2012; 161: 689694.e1.
27. Letshwiti, JB, Semberova, J, Pichova, K, Dempsey, EM, Franklin, OM, Miletin, J. A conservative treatment of patent ductus arteriosus in very low birth weight infants. Early Hum Dev 2017; 104: 4549.
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Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
  • URL: /core/journals/cardiology-in-the-young
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