Treatment of patent ductus arteriosus in very low birth weight infants varies between hospitals

by Molly Munsell, Alex Gipsman, MD

Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. Based on a large US database, 24.6% of very low birth weight (VLBW) infants admitted to neonatal intensive care units (NICUs) were diagnosed with patent ductus arteriosus (PDA), and 20.5% were treated, with a decrease in both diagnosis and treatment rates from 2012-2019.

2. There was significant variation in rate and type of treatment between geographic regions and between individual NICUs.

Evidence Rating Level: 2 (Good)

Study Rundown:

Persistent patent ductus arteriosus (PDA) after birth is common in very low birth weight (VLBW) infants. Though hemodynamically significant PDA is associated with increased neonatal mortality and many significant short- and long-term complications, the role for treatment and optimal treatment protocols remain controversial because spontaneous PDA closure is common. This study aimed to report trends and variation in PDA diagnosis and treatment nationally. Among a total study population of nearly 300,000 VLBW infants, rates of PDA diagnosis decreased between 2012 and 2019. In NICUs with the capability for invasive PDA treatment, 20.3% of infants were treated for PDA compared to 8.9% at those without this capability. A large majority received pharmacologic rather than invasive therapy. Infants in NICUs with invasive treatment capabilities had lower gestational age and birth weight on average, but the difference in treatment rates was not fully explained by this difference in baseline characteristics. PDA treatment rates also varied by geographic region, with the highest treatment rate in New England and lowest in the Mountain, Pacific, and mid-Atlantic regions. The direct implications of this study for clinical decision-making are limited, as short- and long-term outcomes between NICUs and treatment types were not analyzed. However, this very large study reveals significant differences in practice between NICUs and between regions. This suggests a need for further evidence and greater clarity of guidelines around treatment indications for PDA.

In-Depth [retrospective cohort]:

Data were collected from a large US database, the Vermont Oxford Network, on 291,292 VLBW infants treated in 806 NICUs between 2012 and 2019. Infants born at a weight of 401-1500 grams or a gestational age of 22-29 weeks were defined as VLBW. Therapeutic measures were defined as pharmacologic or invasive. Pharmacologic PDA treatments included indomethacin, ibuprofen, and acetaminophen. Invasive treatments included surgical ligation or catheter closure. PDA diagnosis rates among VLBW infants decreased from 28.4% in 2012 to 20.8% in 2019, corresponding to a decrease in treatment rate from 24.2% to 18.6%. 71% of infants in this study were admitted to NICUs with capacity for both pharmacologic and invasive therapy. Only 2% of these infants received invasive therapy.

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