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Variation of Patent Ductus Arteriosus Treatment in Very Low Birth Weight Infants
K Elisabeth Runte1, Jonathan N Flyer1, Erika M Edwards1,2,3
1Department of Pediatrics, Robert Larner, MD, College of Medicine, The University of Vermont and The University of Vermont Children's Hospital, Burlington, Vermont.
Insights
Patent ductus arteriosus (PDA) treatment for very low birth weight (VLBW) infants is decreasing. Wide variations in PDA treatment exist across US neonatal intensive care units (NICUs), influenced by hospital capabilities and geographic location.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Clinical Epidemiology
Background:
- Patent ductus arteriosus (PDA) treatment is a common intervention for very low birth weight (VLBW) infants.
- Existing evidence on PDA treatment risks and benefits is limited, leading to ongoing controversy.
- This study investigates PDA treatment trends and variations within a large, multicenter cohort of VLBW infants in the US.
Purpose of the Study:
- To describe current trends in PDA diagnosis and treatment among VLBW infants.
- To analyze variations in PDA treatment strategies (pharmacologic, invasive, combined) across US neonatal intensive care units (NICUs).
- To examine the correlation between NICU treatment capabilities, geographic distribution, and PDA treatment rates.
Main Methods:
- Analysis of data from 291,292 VLBW infants born between 2012-2019 across 806 US NICUs via the Vermont Oxford Network.
- Categorization of PDA treatment into pharmacologic, invasive, or combined approaches.
- Classification of NICUs based on their capability for invasive PDA treatment and examination of infant/hospital characteristics by NICU type and treatment quartile.
Main Results:
- PDA diagnosis and treatment rates declined over the study period, with 24.6% diagnosed and 20.5% treated.
- Pharmacologic treatment was the predominant approach.
- Significant variation in treatment rates (0%-67%) was observed among NICUs, even with similar infant populations. Higher treatment rates were noted in NICUs capable of invasive treatment and in the Northeast region.
Conclusions:
- PDA diagnosis and treatment rates are decreasing, but significant geographic and hospital-based variations in treatment persist.
- Treatment disparities correlate with NICU capabilities and location, highlighting potential inequities in care.
- Further research into the impact of these treatment variations is crucial for optimizing clinical management of PDA in VLBW infants.
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.
