Variation of Patent Ductus Arteriosus Treatment in Very Low Birth Weight Infants.

Autor:	Runte KE; Department of Pediatrics, Robert Larner, MD, College of Medicine, The University of Vermont and The University of Vermont Children's Hospital, Burlington, Vermont., Flyer JN; Department of Pediatrics, Robert Larner, MD, College of Medicine, The University of Vermont and The University of Vermont Children's Hospital, Burlington, Vermont., Edwards EM; Department of Pediatrics, Robert Larner, MD, College of Medicine, The University of Vermont and The University of Vermont Children's Hospital, Burlington, Vermont.; Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, The University of Vermont, Burlington, Vermont.; Vermont Oxford Network, Burlington, Vermont., Soll RF; Department of Pediatrics, Robert Larner, MD, College of Medicine, The University of Vermont and The University of Vermont Children's Hospital, Burlington, Vermont.; Vermont Oxford Network, Burlington, Vermont.; Neonatology., Horbar JD; Department of Pediatrics, Robert Larner, MD, College of Medicine, The University of Vermont and The University of Vermont Children's Hospital, Burlington, Vermont.; Vermont Oxford Network, Burlington, Vermont.; Neonatology., Yeager SB; Department of Pediatrics, Robert Larner, MD, College of Medicine, The University of Vermont and The University of Vermont Children's Hospital, Burlington, Vermont scott.yeager@uvmhealth.org.
Jazyk:	angličtina
Zdroj:	Pediatrics [Pediatrics] 2021 Nov; Vol. 148 (5). Date of Electronic Publication: 2021 Oct 21.
DOI:	10.1542/peds.2021-052874
Abstrakt:	Background: Patent ductus arteriosus (PDA) treatment is common among very low birth weight (VLBW) infants. Given limitations in evidence, controversy exists regarding treatment risks and benefits. In this study, we describe PDA treatment trends and variation in a large, US, multicenter VLBW infant cohort. Methods: Data were collected through Vermont Oxford Network on 291 292 VLBW infants born 2012-2019 at 806 US NICUs. PDA diagnosis and treatment rates, further categorized as pharmacologic, invasive, or combined, were determined. NICUs were classified as capable versus noncapable of invasive PDA treatment. Infant and hospital characteristics were examined by NICU type and treatment quartile. Geographic NICU distribution and treatment rates were described in 9 US census divisions. Results: Of all infants, 24.6% were diagnosed with and 20.5% were treated for PDA. Diagnosis and treatment rates decreased over the study period. Treatment was predominantly pharmacologic. Treatment rates varied widely among NICUs (0% to 67%) despite similar infant characteristics. The median treatment rate was higher at NICUs capable of pharmacologic and invasive treatment (20.3%, interquartile range 13.3-28.6) than at NICUs capable of only pharmacologic treatment (8.9%, interquartile range 2.9-14.8). Treatment rates were highest in the northeast and lowest in the west. Invasive treatment was more common in the west. Conclusions: PDA diagnosis and treatment rates are trending downward. Wide variation exists in PDA treatment despite a largely uniform VLBW infant population. This variation correlates with differences in hospital treatment capabilities and geography. Further understanding of the effects of treatment disparity could aid in guiding clinical management. Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. (Copyright © 2021 by the American Academy of Pediatrics.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu