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

Published online by Cambridge University Press:  19 June 2017

Jan Hau Lee
Affiliation:
Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore Duke-NUS School of Medicine, Singapore
Rachel G. Greenberg
Affiliation:
Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, United States of America Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, United States of America
Bin H. Quek
Affiliation:
Duke-NUS School of Medicine, Singapore Department of Neonatology, KK Women’s and Children’s Hospital, Singapore
Reese H. Clark
Affiliation:
Pediatrix-Obstetrix Center for Research and Education, Sunrise, Florida, United States of America
Matthew M. Laughon
Affiliation:
Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
P. Brian Smith
Affiliation:
Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, United States of America Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, United States of America
Christoph P. Hornik*
Affiliation:
Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, United States of America Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, United States of America
*
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

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.

Type
Original Articles
Copyright
© Cambridge University Press 2017 

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