Am J Perinatol 2015; 32(04): 379-386
DOI: 10.1055/s-0034-1387931
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Hospital Variation in Medical and Surgical Treatment of Patent Ductus Arteriosus

Henry C. Lee
1   Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Palo Alto, California
2   California Perinatal Quality Care Collaborative, Palo Alto, California
,
David J. Durand
3   Division of Neonatology, Department of Pediatrics, Children's Hospital and Research Center, Oakland, California
,
Beate Danielsen
4   Health Information Solutions, Roseville, California
,
Grace Villarin Dueñas
2   California Perinatal Quality Care Collaborative, Palo Alto, California
,
Richard J. Powers
5   Division of Neonatology, Department of Pediatrics, Good Samaritan Hospital, San Jose, California
› Author Affiliations
Further Information

Publication History

09 May 2014

25 June 2014

Publication Date:
21 September 2014 (online)

Abstract

Objective This study aims to characterize population risks for diagnosis, medical treatment, and surgical ligation of patent ductus arteriosus (PDA) in very low-birth-weight infants.

Study Design Maternal and neonatal data were collected in 40 hospitals in California during 2011 for infants with birth weight ≤ 1,500 g without any congenital malformation, with a diagnosis of PDA. Multivariable logistic regression was used to determine independent risks for PDA diagnosis and for surgical ligation.

Results There were 770/1,902 (40.4%) infants diagnosed with PDA. Low birth weight, gestational age, respiratory distress syndrome, and surfactant administration were associated with PDA diagnosis. Ligation occurred in 43% of patients with birth weight ≤ 750 g, in 24% of patients weighing between 715 and 1,000 g, and in 12% of patients weighing from 1,001 to 1,500 g. Older gestational age (1 week, odds ratio 0.55, 95% confidence interval 0.48–0.63) and absence of respiratory distress syndrome (odds ratio 0.14, 95% confidence interval 0.03–0.59) were associated with lower ligation risk. The median hospital ligation rate was 14% (interquartile range 0–38%).

Conclusion Most patients with PDA receive treatment for closure. Practice variation may set the stage for further exploration of experimental trials.

 
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