Changes in the Diagnosis and Management of Patent Ductus Arteriosus from 2006 to 2015 in United States Neonatal Intensive Care Units
Objective To identify changes in the diagnosis, pharmacotherapy, and surgical ligation of patent ductus arteriosus (PDAs) in infants born premature and report on temporal changes in mortality and morbidity from a large volume of neonatal intensive care units (NICUs) in the US. Study design We querie...
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| Veröffentlicht in: | The Journal of pediatrics 2017-10, Vol.189, p.105-112 |
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| container_title | The Journal of pediatrics |
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| creator | Bixler, G. Michael, MD Powers, George C., MD Clark, Reese H., MD Walker, M. Whit, MD Tolia, Veeral N., MD |
| description | Objective To identify changes in the diagnosis, pharmacotherapy, and surgical ligation of patent ductus arteriosus (PDAs) in infants born premature and report on temporal changes in mortality and morbidity from a large volume of neonatal intensive care units (NICUs) in the US. Study design We queried the Pediatrix Clinical Data Warehouse for all inborn infants without major anomalies born between 23 and 30 weeks' gestation from 2006 to 2015 for a diagnosis of PDA, use of indomethacin or ibuprofen, history of ductal ligation, mortality, and major morbidities. Results There were 829 091 infants entered in the Clinical Data Warehouse; 61 520 infants from 280 NICUs met our inclusion criteria. The diagnosis of PDA declined from 51% to 38% ( P |
| doi_str_mv | 10.1016/j.jpeds.2017.05.024 |
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Michael, MD ; Powers, George C., MD ; Clark, Reese H., MD ; Walker, M. Whit, MD ; Tolia, Veeral N., MD</creator><creatorcontrib>Bixler, G. Michael, MD ; Powers, George C., MD ; Clark, Reese H., MD ; Walker, M. Whit, MD ; Tolia, Veeral N., MD</creatorcontrib><description>Objective To identify changes in the diagnosis, pharmacotherapy, and surgical ligation of patent ductus arteriosus (PDAs) in infants born premature and report on temporal changes in mortality and morbidity from a large volume of neonatal intensive care units (NICUs) in the US. Study design We queried the Pediatrix Clinical Data Warehouse for all inborn infants without major anomalies born between 23 and 30 weeks' gestation from 2006 to 2015 for a diagnosis of PDA, use of indomethacin or ibuprofen, history of ductal ligation, mortality, and major morbidities. Results There were 829 091 infants entered in the Clinical Data Warehouse; 61 520 infants from 280 NICUs met our inclusion criteria. The diagnosis of PDA declined from 51% to 38% ( P < .001), use of indomethacin or ibuprofen decreased from 32% to 18%, and PDA ligation decreased from 8.4% to 2.9% (both P < .001). During the study period, mortality decreased with no increase in any measured morbidity. Of the 163 sites with data for both periods, 128 (79%) showed a decrease in the diagnosis of PDA, and 132 (81%) showed a decrease in the use indomethacin and/or ibuprofen when 2011-2015 was compared with 2006-2010. Of 103 sites with at least 1 PDA ligation, 85 (83%) showed a decrease in PDA ligation in a similar comparison. Conclusions In this large population of infants <30 weeks' gestation from 280 NICUs across the US, there were significant decreases in the diagnosis and treatment of the PDA. Although there was no evidence of increased morbidities, it remains uncertain how these changes may directly affect infant outcomes.</description><identifier>ISSN: 0022-3476</identifier><identifier>EISSN: 1097-6833</identifier><identifier>DOI: 10.1016/j.jpeds.2017.05.024</identifier><identifier>PMID: 28600155</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>conservative management ; Cyclooxygenase Inhibitors - therapeutic use ; Databases, Factual ; ductal ligation ; Ductus Arteriosus, Patent - diagnosis ; Ductus Arteriosus, Patent - mortality ; Ductus Arteriosus, Patent - therapy ; Humans ; ibuprofen ; Ibuprofen - therapeutic use ; indomethacin ; Indomethacin - therapeutic use ; Infant, Newborn ; Infant, Premature ; Intensive Care Units, Neonatal - statistics & numerical data ; Ligation - methods ; Ligation - statistics & numerical data ; Pediatrics ; United States ; variation</subject><ispartof>The Journal of pediatrics, 2017-10, Vol.189, p.105-112</ispartof><rights>Elsevier Inc.</rights><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c480t-964e8d80966cff7702674a52d30497340d81926bf30fb301a6103e8fc5d8f35c3</citedby><cites>FETCH-LOGICAL-c480t-964e8d80966cff7702674a52d30497340d81926bf30fb301a6103e8fc5d8f35c3</cites><orcidid>0000-0002-7363-4640</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022347617306455$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28600155$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bixler, G. Michael, MD</creatorcontrib><creatorcontrib>Powers, George C., MD</creatorcontrib><creatorcontrib>Clark, Reese H., MD</creatorcontrib><creatorcontrib>Walker, M. Whit, MD</creatorcontrib><creatorcontrib>Tolia, Veeral N., MD</creatorcontrib><title>Changes in the Diagnosis and Management of Patent Ductus Arteriosus from 2006 to 2015 in United States Neonatal Intensive Care Units</title><title>The Journal of pediatrics</title><addtitle>J Pediatr</addtitle><description>Objective To identify changes in the diagnosis, pharmacotherapy, and surgical ligation of patent ductus arteriosus (PDAs) in infants born premature and report on temporal changes in mortality and morbidity from a large volume of neonatal intensive care units (NICUs) in the US. Study design We queried the Pediatrix Clinical Data Warehouse for all inborn infants without major anomalies born between 23 and 30 weeks' gestation from 2006 to 2015 for a diagnosis of PDA, use of indomethacin or ibuprofen, history of ductal ligation, mortality, and major morbidities. Results There were 829 091 infants entered in the Clinical Data Warehouse; 61 520 infants from 280 NICUs met our inclusion criteria. The diagnosis of PDA declined from 51% to 38% ( P < .001), use of indomethacin or ibuprofen decreased from 32% to 18%, and PDA ligation decreased from 8.4% to 2.9% (both P < .001). During the study period, mortality decreased with no increase in any measured morbidity. Of the 163 sites with data for both periods, 128 (79%) showed a decrease in the diagnosis of PDA, and 132 (81%) showed a decrease in the use indomethacin and/or ibuprofen when 2011-2015 was compared with 2006-2010. Of 103 sites with at least 1 PDA ligation, 85 (83%) showed a decrease in PDA ligation in a similar comparison. Conclusions In this large population of infants <30 weeks' gestation from 280 NICUs across the US, there were significant decreases in the diagnosis and treatment of the PDA. Although there was no evidence of increased morbidities, it remains uncertain how these changes may directly affect infant outcomes.</description><subject>conservative management</subject><subject>Cyclooxygenase Inhibitors - therapeutic use</subject><subject>Databases, Factual</subject><subject>ductal ligation</subject><subject>Ductus Arteriosus, Patent - diagnosis</subject><subject>Ductus Arteriosus, Patent - mortality</subject><subject>Ductus Arteriosus, Patent - therapy</subject><subject>Humans</subject><subject>ibuprofen</subject><subject>Ibuprofen - therapeutic use</subject><subject>indomethacin</subject><subject>Indomethacin - therapeutic use</subject><subject>Infant, Newborn</subject><subject>Infant, Premature</subject><subject>Intensive Care Units, Neonatal - statistics & numerical data</subject><subject>Ligation - methods</subject><subject>Ligation - statistics & numerical data</subject><subject>Pediatrics</subject><subject>United States</subject><subject>variation</subject><issn>0022-3476</issn><issn>1097-6833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkktv1DAQxyMEokvhEyAhH7kkjB9xkgNI1ZZHpfKQSs-W15lsHRJ7sZ1KvfPBcbqFAxdOM4f_w_5piuIlhYoClW_GajxgHysGtKmgroCJR8WGQteUsuX8cbEBYKzkopEnxbMYRwDoBMDT4oS1EoDW9ab4tb3Rbo-RWEfSDZJzq_fORxuJdj35rJ3e44wuET-Qbzqt2_li0hLJWUgYrI95HYKfCQOQJPk8ab2mXTubsCdXKbsi-YLe6aQncuFySLS3SLY64L0qPi-eDHqK-OJhnhbXH95_334qL79-vNieXZZGtJDKTgps-xY6Kc0wNA0w2Qhds56D6BouoG9px-Ru4DDsOFAtKXBsB1P37cBrw0-L18fcQ_A_F4xJzTYanCbt0C9R0Q5awdpclqX8KDXBxxhwUIdgZx3uFAW14lejusevVvwKapXxZ9erh4JlN2P_1_OHdxa8PQowf_PWYlDRWHQGexvQJNV7-5-Cd__4zWSdNXr6gXcYR78ElwkqqiJToK7WC1gPgDYcpMgP-A0beqpE</recordid><startdate>20171001</startdate><enddate>20171001</enddate><creator>Bixler, G. Michael, MD</creator><creator>Powers, George C., MD</creator><creator>Clark, Reese H., MD</creator><creator>Walker, M. Whit, MD</creator><creator>Tolia, Veeral N., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7363-4640</orcidid></search><sort><creationdate>20171001</creationdate><title>Changes in the Diagnosis and Management of Patent Ductus Arteriosus from 2006 to 2015 in United States Neonatal Intensive Care Units</title><author>Bixler, G. Michael, MD ; Powers, George C., MD ; Clark, Reese H., MD ; Walker, M. Whit, MD ; Tolia, Veeral N., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c480t-964e8d80966cff7702674a52d30497340d81926bf30fb301a6103e8fc5d8f35c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>conservative management</topic><topic>Cyclooxygenase Inhibitors - therapeutic use</topic><topic>Databases, Factual</topic><topic>ductal ligation</topic><topic>Ductus Arteriosus, Patent - diagnosis</topic><topic>Ductus Arteriosus, Patent - mortality</topic><topic>Ductus Arteriosus, Patent - therapy</topic><topic>Humans</topic><topic>ibuprofen</topic><topic>Ibuprofen - therapeutic use</topic><topic>indomethacin</topic><topic>Indomethacin - therapeutic use</topic><topic>Infant, Newborn</topic><topic>Infant, Premature</topic><topic>Intensive Care Units, Neonatal - statistics & numerical data</topic><topic>Ligation - methods</topic><topic>Ligation - statistics & numerical data</topic><topic>Pediatrics</topic><topic>United States</topic><topic>variation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bixler, G. Michael, MD</creatorcontrib><creatorcontrib>Powers, George C., MD</creatorcontrib><creatorcontrib>Clark, Reese H., MD</creatorcontrib><creatorcontrib>Walker, M. Whit, MD</creatorcontrib><creatorcontrib>Tolia, Veeral N., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bixler, G. Michael, MD</au><au>Powers, George C., MD</au><au>Clark, Reese H., MD</au><au>Walker, M. Whit, MD</au><au>Tolia, Veeral N., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Changes in the Diagnosis and Management of Patent Ductus Arteriosus from 2006 to 2015 in United States Neonatal Intensive Care Units</atitle><jtitle>The Journal of pediatrics</jtitle><addtitle>J Pediatr</addtitle><date>2017-10-01</date><risdate>2017</risdate><volume>189</volume><spage>105</spage><epage>112</epage><pages>105-112</pages><issn>0022-3476</issn><eissn>1097-6833</eissn><abstract>Objective To identify changes in the diagnosis, pharmacotherapy, and surgical ligation of patent ductus arteriosus (PDAs) in infants born premature and report on temporal changes in mortality and morbidity from a large volume of neonatal intensive care units (NICUs) in the US. Study design We queried the Pediatrix Clinical Data Warehouse for all inborn infants without major anomalies born between 23 and 30 weeks' gestation from 2006 to 2015 for a diagnosis of PDA, use of indomethacin or ibuprofen, history of ductal ligation, mortality, and major morbidities. Results There were 829 091 infants entered in the Clinical Data Warehouse; 61 520 infants from 280 NICUs met our inclusion criteria. The diagnosis of PDA declined from 51% to 38% ( P < .001), use of indomethacin or ibuprofen decreased from 32% to 18%, and PDA ligation decreased from 8.4% to 2.9% (both P < .001). During the study period, mortality decreased with no increase in any measured morbidity. Of the 163 sites with data for both periods, 128 (79%) showed a decrease in the diagnosis of PDA, and 132 (81%) showed a decrease in the use indomethacin and/or ibuprofen when 2011-2015 was compared with 2006-2010. Of 103 sites with at least 1 PDA ligation, 85 (83%) showed a decrease in PDA ligation in a similar comparison. Conclusions In this large population of infants <30 weeks' gestation from 280 NICUs across the US, there were significant decreases in the diagnosis and treatment of the PDA. Although there was no evidence of increased morbidities, it remains uncertain how these changes may directly affect infant outcomes.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28600155</pmid><doi>10.1016/j.jpeds.2017.05.024</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-7363-4640</orcidid></addata></record> |
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| subjects | conservative management Cyclooxygenase Inhibitors - therapeutic use Databases, Factual ductal ligation Ductus Arteriosus, Patent - diagnosis Ductus Arteriosus, Patent - mortality Ductus Arteriosus, Patent - therapy Humans ibuprofen Ibuprofen - therapeutic use indomethacin Indomethacin - therapeutic use Infant, Newborn Infant, Premature Intensive Care Units, Neonatal - statistics & numerical data Ligation - methods Ligation - statistics & numerical data Pediatrics United States variation |
| title | Changes in the Diagnosis and Management of Patent Ductus Arteriosus from 2006 to 2015 in United States Neonatal Intensive Care Units |
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