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Changes in Patent Ductus Arteriosus Management and Outcomes in Infants Born at 26-28 Weeks' Gestation
Dinushan C Kaluarachchi1, Matthew A Rysavy2, Barbara T Do3
1Department of Pediatrics, University of Wisconsin-Madison, Madison, WI.
Insights
Decreased treatment for patent ductus arteriosus (PDA) in premature infants was linked to more bronchopulmonary dysplasia (BPD). Further research is needed to understand the rise in BPD and its causes.
Area of Science:
- Neonatal Medicine
- Perinatal Research
- Pediatric Cardiology
Background:
- Patent ductus arteriosus (PDA) is a common condition in preterm infants.
- Trends in PDA treatment have evolved over the past decade.
- Understanding the impact of treatment changes on neonatal outcomes is crucial.
Purpose of the Study:
- To examine the association between declining PDA treatment rates and neonatal outcomes.
- To investigate trends in mortality and morbidity for infants born between 26 0/7 and 28 6/7 weeks' gestation.
- To analyze the relationship between temporal changes in PDA management and infant health outcomes.
Main Methods:
- Retrospective cohort study of 7864 infants born between 2012-2021.
- Utilized data from the NICHD Neonatal Research Network.
- Analyzed composite outcomes (necrotizing enterocolitis, BPD, intraventricular hemorrhage, death) using multilevel models, stratified by hospital PDA treatment changes.
Main Results:
- A decrease in PDA treatment from 21% to 16% was observed (P < .01).
- The primary composite outcome increased from 24% to 36% (P < .01), largely driven by increased grade 2-3 bronchopulmonary dysplasia (BPD).
- Decreased PDA treatment correlated with increased primary outcomes and BPD, but BPD rose across all hospitals regardless of PDA treatment changes.
Conclusions:
- Temporal decreases in PDA treatment for very preterm infants (26-28 weeks) coincided with an increase in grade 2-3 BPD.
- Causality between reduced PDA treatment and increased BPD requires cautious interpretation.
- Further investigation into the reasons for the rising incidence of BPD is warranted.
Objective:
To investigate the association between the secular decrease in treatment of patent ductus arteriosus (PDA) and trends in neonatal mortality and morbidity in infants born at 26 0/7-28 6/7 weeks' gestation.
Study Design:
A retrospective cohort study including infants born between 2012 and 2021 in continually participating hospitals in the National Institute of Child Health and Human Development Neonatal Research Network. The primary composite outcome was defined as surgical necrotizing enterocolitis, grade 2-3 bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage, or death. Relationships of temporal trends in PDA treatment with the primary composite outcome and its components were analyzed using a multilevel model accounting for patient-level factors. A separate analysis assessed these relationships stratified by hospital changes in PDA treatment.
Results:
The study included 7864 infants. There was a decrease in any PDA treatment from 21% to 16% (P < .01) and an increase in the primary composite outcome from 24% to 36% (P < .01). Change in the primary outcome was driven by increased grade 2-3 BPD (13%-26%, P < .01), with grade 2 BPD accounting for most of this increase (10%-22%, P < .01). Temporal decreases in PDA treatment were associated with increases in the primary outcome and grade 2-3 BPD after adjusting for patient-level factors (P < .01). However, stratified analyses showed that grade 2-3 BPD increased in all hospital groups, regardless of changes in PDA management.
Conclusions:
From 2012 to 2021, temporal decreases in PDA treatment for infants 26-28 weeks were associated with an increase in grade 2-3 BPD. However, caution is warranted in determining causality. Reasons for increased grade 2-3 BPD during the past decade warrant investigation.
Trial Registration:
Generic Database: NCT00063063.
