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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 ,
Rachel G. Greenberg ,
Bin H. Quek ,
Reese H. Clark ,
Matthew M. Laughon ,
P. Brian Smith  and
Christoph P. Hornik
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
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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.

Keywords

Cardiologyechocardiographyneonatepatent ductus arteriosusmortality
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 9 , November 2017 , pp. 1732 - 1739
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Copyright
© Cambridge University Press 2017 

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References

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: e138–e144.Google Scholar
2. Benitz, WE. Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis? J Perinatol 2010; 30: 241–252.Google Scholar
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: F505–F510.Google Scholar
4. Benitz, WE. Patent ductus arteriosus in preterm infants. Pediatrics 2016; 137: 1–6.Google Scholar
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: 1939–1944.Google Scholar
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: 87–92.Google Scholar
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: 423–432.Google Scholar
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: 1048–1053.Google Scholar
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: 205–211.Google Scholar
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: 2441–2448.Google Scholar
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: 49–70.Google Scholar
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: 955–960.e1.Google Scholar
13. Kliegman, RM, Walsh, MC. Neonatal necrotizing enterocolitis: pathogenesis, classification, and spectrum of illness. Curr Probl Pediatr 1987; 17: 213–288.Google Scholar
14. Hamrick, SE, Hansmann, G. Patent ductus arteriosus of the preterm infant. Pediatrics 2010; 125: 1020–1030.Google Scholar
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: F45–F52.Google Scholar
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.Google Scholar
17. Kluckow, M, Evans, N. Early echocardiographic prediction of symptomatic patent ductus arteriosus in preterm infants undergoing mechanical ventilation. J Pediatr 1995; 127: 774–779.Google Scholar
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: 161–164.Google Scholar
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: F424–F427.Google Scholar
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: F133–F137.Google Scholar
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: 325–329.Google Scholar
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: 125–130.Google Scholar
23. de Waal, K, Kluckow, M. Functional echocardiography; from physiology to treatment. Early Hum Dev 2010; 86: 149–154.Google Scholar
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: 340–345.Google Scholar
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: 440–446.Google Scholar
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: 689–694.e1.Google Scholar
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: 45–49.Google Scholar