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Using benchmarking to identify inter-centre differences in persistent ductus arteriosus treatment: can we improve outcome?

Published online by Cambridge University Press:  12 April 2017

Esther J. S. Jansen ,
Koen P. Dijkman ,
Richard A. van Lingen ,
Willem B. de Vries ,
Daniel C. Vijlbrief ,
Willem P. de Boode  and
Peter Andriessen
Esther J. S. Jansen
Affiliation:
Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands
Koen P. Dijkman
Affiliation:
Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands
Richard A. van Lingen
Affiliation:
Department of Neonatology, Amalia Children’s Centre Isala, Zwolle, The Netherlands
Willem B. de Vries
Affiliation:
Department of Neonatology, University Medical Centre Utrecht, Utrecht, The Netherlands
Daniel C. Vijlbrief
Affiliation:
Department of Neonatology, University Medical Centre Utrecht, Utrecht, The Netherlands
Willem P. de Boode*
Affiliation:
Department of Neonatology, Radboudumc, Nijmegen, The Netherlands
Peter Andriessen
Affiliation:
Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands Faculty of Health, Medicine and Life Science, Maastricht University, Maastricht, The Netherlands
*
Correspondence to: W. P. de Boode, Department of Neonatology, Radboudumc, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Tel: +31 24 3611111; Fax: +31 24 361 64 28; E-mail: willem.deboode@radboudumc.nl
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Abstract

Objective

The aim of this study was to identify inter-centre differences in persistent ductus arteriosus treatment and their related outcomes.

Materials and methods

We carried out a retrospective, multicentre study including infants between 24+0 and 27+6 weeks of gestation in the period between 2010 and 2011. In all centres, echocardiography was used as the standard procedure to diagnose a patent ductus arteriosus and to document ductal closure.

Results

In total, 367 preterm infants were included. All four participating neonatal ICU had a comparable number of preterm infants; however, differences were observed in the incidence of treatment (33–63%), choice and dosing of medication (ibuprofen or indomethacin), number of pharmacological courses (1–4), and the need for surgical ligation after failure of pharmacological treatment (8–52%). Despite the differences in treatment, we found no difference in short-term morbidity between the centres. Adjusted mortality showed independent risk contribution of gestational age, birth weight, ductal ligation, and perinatal centre.

Conclusions

Using benchmarking as a tool identified inter-centre differences. In these four perinatal centres, the factors that explained the differences in patent ductus arteriosus treatment are quite complex. Timing, choice of medication, and dosing are probably important determinants for successful patent ductus arteriosus closure.

Keywords

Patent ductus arteriosusibuprofenindomethacinductal ligationnewbornpatent ductus arteriosus
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 8 , October 2017 , pp. 1488 - 1496
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Copyright
© Cambridge University Press 2017 

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