Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-24T09:24:10.887Z Has data issue: false hasContentIssue false
  • English
  • Français

Surgical ligation of patent ductus arteriosus in premature infants: trends and practice variation

Published online by Cambridge University Press:  23 September 2015

Jacqueline G. Weinberg ,
Frank J. Evans ,
Kristin M. Burns ,
Gail D. Pearson  and
Jonathan R. Kaltman
Jacqueline G. Weinberg*
Affiliation:
National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America Department of Pediatrics, Division of Cardiology, Children’s National Health System, Washington, District of Columbia, United States of America
Frank J. Evans
Affiliation:
National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
Kristin M. Burns
Affiliation:
National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America Department of Pediatrics, Division of Cardiology, Children’s National Health System, Washington, District of Columbia, United States of America
Gail D. Pearson
Affiliation:
National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America Department of Pediatrics, Division of Cardiology, Children’s National Health System, Washington, District of Columbia, United States of America
Jonathan R. Kaltman
Affiliation:
National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America Department of Pediatrics, Division of Cardiology, Children’s National Health System, Washington, District of Columbia, United States of America
*
Correspondence to: J. Weinberg, MD, Division of Cardiology, Children’s National Medical Center, 111 Michigan Avenue NW, Suite W3-200, Washington, DC 20010, United States of America. Tel: +202 476 2020; Fax: +202 476 5700; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

We sought to analyse the variation in the incidence of patent ductus arteriosus over three recent time points and characterise ductal ligation practices in preterm infants in the United States, adjusting for demographic and morbidity factors.

Methods

Using the Kids’ Inpatient Database from 2003, 2006, and 2009, we identified infants born at ⩽32 weeks of gestation with International Classification of Diseases, Ninth Revision diagnosis of patent ductus arteriosus and ligation code. We examined patient and hospital characteristics and identified patient and hospital variables associated with ligation.

Results

Of 182,610 preterm births, 30,714 discharges included a patent ductus arteriosus diagnosis. The rate of patent ductus arteriosus diagnosis increased from 14% in 2003 to 21% in 2009 (p<0.001). A total of 4181 ligations were performed, with an overall ligation rate of 14%. Ligation rate in infants born at ⩽28 weeks of gestation was 20% overall, increasing from 18% in 2003 to 21% in 2009 (p<0.001). The ligation rate varied by state (4–28%), and ligation was associated with earlier gestational age, associated diagnoses, hospital type, teaching hospital status, and region (p<0.001).

Conclusion

The rates of patent ductus arteriosus diagnosis and ligation have increased in the recent years. Variation exists in the practice of patent ductus arteriosus ligation and is influenced by patient and non-patient factors.

Keywords

Patent ductus arteriosuspreterm infantsurgical ligationneonate
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 6 , August 2016 , pp. 1107 - 1114
Check for updates
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Koch, J, Hensley, G, Roy, L, Brown, S, Ramaciotti, C, Rosenfeld, CR. Prevalence of spontaneous closure of the ductus arteriosus in neonates at a birth weight of 1000 grams or less. Pediatrics 2006; 117: 1113–1121.Google Scholar
2. Fanaroff, AA, Stoll, BJ, Wright, LL, et al. Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol 2007; 196: 147 e141–147 e148.Google Scholar
3. Cassady, G, Crouse, DT, Kirklin, JW, et al. A randomized, controlled trial of very early prophylactic ligation of the ductus arteriosus in babies who weighed 1000 g or less at birth. N Engl J Med 1989; 320: 1511–1516.Google Scholar
4. Costeloe, K, Hennessy, E, Gibson, AT, Marlow, N, Wilkinson, AR. The EPICure study: outcomes to discharge from hospital for infants born at the threshold of viability. Pediatrics 2000; 106: 659–671.Google Scholar
5. Hintz, SR, Kendrick, DE, Wilson-Costello, DE, et al. Early-childhood neurodevelopmental outcomes are not improving for infants born at <25 weeks’ gestational age. Pediatrics 2011; 127: 62–70.Google Scholar
6. Shah, PS, Sankaran, K, Aziz, K, et al. Outcomes of preterm infants <29 weeks gestation over 10-year period in Canada: a cause for concern? J Perinatol 2012; 32: 132–138.Google Scholar
7. Moore, P, Brook, MM. Patent ductus arteriosus and aortopulmonary window. In: Allen HD, Driscoll DJ, Shaddy RE, Feltes TF (eds). Moss and Adams’ Heart Disease in Infants, Children and Adolescents, Including the Fetus and Young Adult, 8th edn. Lippincott Williams & Wilkins, a Wolters Kluwer Business, Philadelphia, PA, 2013: 722–745.Google Scholar
8. Little, DC, Pratt, TC, Blalock, SE, Krauss, DR, Cooney, DR, Custer, MD. Patent ductus arteriosus in micropreemies and full-term infants: the relative merits of surgical ligation versus indomethacin treatment. J Pediatr Surg 2003; 38: 492–496.Google Scholar
9. Vida, VL, Lago, P, Salvatori, S, et al. Is there an optimal timing for surgical ligation of patent ductus arteriosus in preterm infants? Ann Thorac Surg 2009; 87: 1509–1515; discussion 1515–1506.Google Scholar
10. Dollberg, S, Lusky, A, Reichman, B. Patent ductus arteriosus, indomethacin and necrotizing enterocolitis in very low birth weight infants: a population-based study. J Pediatr Gastroenterol Nutr 2005; 40: 184–188.Google Scholar
11. Evans, N, Kluckow, M. Early ductal shunting and intraventricular haemorrhage in ventilated preterm infants. Arch Dis Child Fetal Neonatal Ed 1996; 75: F183–F186.Google Scholar
12. Finlay, ER, Subhedar, NV. Pulmonary haemorrhage in preterm infants. Eur J Pediatr 2000; 159: 870–871.Google Scholar
13. Brooks, JM, Travadi, JN, Patole, SK, Doherty, DA, Simmer, K. Is surgical ligation of patent ductus arteriosus necessary? The Western Australian experience of conservative management. Arch Dis Child Fetal Neonatal Ed 2005; 90: F235–F239.CrossRefGoogle ScholarPubMed
14. Noori, S, McCoy, M, Friedlich, P, et al. Failure of ductus arteriosus closure is associated with increased mortality in preterm infants. Pediatrics 2009; 123: e138–e144.Google Scholar
15. Benitz, WE. Patent ductus arteriosus: to treat or not to treat? Arch Dis Child Fetal Neonatal Ed 2012; 97: F80–F82.Google Scholar
16. Noori, S. Patent ductus arteriosus in the preterm infant: to treat or not to treat? J Perinatol 2010; 30 (Suppl): S31–S37.Google Scholar
17. Clyman, RI, Couto, J, Murphy, GM. Patent ductus arteriosus: are current neonatal treatment options better or worse than no treatment at all? Semin Perinatol 2012; 36: 123–129.Google Scholar
18. Sehgal, A, McNamara, PJ. The ductus arteriosus: a refined approach!. Semin Perinatol 2012; 36: 105–113.Google Scholar
19. El-Khuffash, AF, Jain, A, Weisz, D, Mertens, L, McNamara, PJ. Assessment and treatment of post patent ductus arteriosus ligation syndrome. J Pediatr 2014; 165: 46–52.Google Scholar
20. El-Khuffash, AF, Jain, A, McNamara, PJ. Ligation of the patent ductus arteriosus in preterm infants: understanding the physiology. J Pediatr 2013; 162: 1100–1106.CrossRefGoogle ScholarPubMed
21. Madan, JC, Kendrick, D, Hagadorn, JI, Frantz, ID 3rd. Patent ductus arteriosus therapy: impact on neonatal and 18-month outcome. Pediatrics 2009; 123: 674–681.Google Scholar
22. Jaillard, S, Larrue, B, Rakza, T, Magnenant, E, Warembourg, H, Storme, L. Consequences of delayed surgical closure of patent ductus arteriosus in very premature infants. Ann Thorac Surg 2006; 81: 231–234.Google Scholar
23. Yon, TF, Amka, P, Pildes, RS, Tatooles, CJ. Diaphragmatic paralysis after surgical ligation of patent ductus arteriosus. Lancet 1977; 2: 461.Google Scholar
24. Gould, DS, Montenegro, LM, Gaynor, JW, et al. A comparison of on-site and off-site patent ductus arteriosus ligation in premature infants. Pediatrics 2003; 112 (6 Pt 1): 1298–1301.Google Scholar
25. Kabra, NS, Schmidt, B, Roberts, RS, Doyle, LW, Papile, L, Fanaroff, A. Neurosensory impairment after surgical closure of patent ductus arteriosus in extremely low birth weight infants: results from the Trial of Indomethacin Prophylaxis in Preterms. J Pediatr 2007; 150: 229–234.Google Scholar
26. Clyman, R, Cassady, G, Kirklin, JK, Collins, M, Philips, JB 3rd. The role of patent ductus arteriosus ligation in bronchopulmonary dysplasia: reexamining a randomized controlled trial. J Pediatr 2009; 154: 873–876.Google Scholar
27. Weisz, DE, McNamara, PJ. Patent ductus arteriosus ligation and adverse outcomes: causality or bias? J Clin Neonatol 2014; 3: 67–75.Google Scholar
28. Nemerofsky, SL, Parravicini, E, Bateman, D, Kleinman, C, Polin, RA, Lorenz, JM. The ductus arteriosus rarely requires treatment in infants >1000 grams. Am J Perinatol 2008; 25: 661–666.Google Scholar
29. Herrman, K, Bose, C, Lewis, K, Laughon, M. Spontaneous closure of the patent ductus arteriosus in very low birth weight infants following discharge from the neonatal unit. Arch Dis Child Fetal Neonatal Ed 2009; 94: F48–F50.Google Scholar
30. Gersony, WM, Peckham, GJ, Ellison, RC, Miettinen, OS, Nadas, AS. Effects of indomethacin in premature infants with patent ductus arteriosus: results of a National Collaborative Study. J Pediatr 1983; 102: 895–906.CrossRefGoogle ScholarPubMed
31. Cotton, RB, Stahlman, MT, Bender, HW, Graham, TP, Catterton, WZ, Kovar, I. Randomized trial of early closure of symptomatic patent ductus arteriosus in small preterm infants. J Pediatr 1978; 93: 647–651.Google Scholar
32. HCUP Kids’ Inpatient Database (KID). Healthcare Cost and Utilization Project (HCUP). 2003, 2006, 2009. Agency for Healthcare Research and Quality, Rockville, MD. Retrieved January 24, 2013, from www.hcup-us.ahrq.gov/kidoverview.jsp Google Scholar
33. Calculating Kids’ Inpatient Database (KID) Variances. Methods series report #2005-5. Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality, Rockville, MD (December 16, 2005). Retrieved January 24, 2013, from http://www.hcup-us.ahrq.gov/db/nation/kid/reports/CalculatingKIDVariances.pdf Google Scholar
34. HCUP Data Use Training. Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality, Rockville, MD (November, 2011). Retrieved July 27, 2012, from http://www.hcup-us.ahrq.gov/tech_assist/dua.jsp Google Scholar
35. American Medical Association. International Classification of Diseases, 9th Revision, Clinical Modification: Physician ICD-9-CM. AMA Press, Chicago, IL, 1996.Google Scholar
36. Bialkowski, J. Patent ductus arteriosus at low and high altitudes: anatomical and haemodynamic features and their implications for transcatheter closure. Kardiologica Polska 2011; 69: 431–436.Google ScholarPubMed
37. U.S. Census Bureau. Statistical Abstract of the United States: 2012, 131st edn. U.S. Census Bureau, Washington, DC, 2011, http://www.census.gov/compendia/statab/ Google Scholar
38. Archer, KJ, Lemeshow, S, Hosmer, DW. Goodness-of-fit tests for logistic regression models when data are collected using a complex sampling design. Comput Stat Data Anal 2007; 51: 4450–4464.Google Scholar
39. Odetola, FO, Tilford, JM, Davis, MM. Variation in the use of intracranial-pressure monitoring and mortality in critically ill children with meningitis in the United States. Pediatrics 2006; 117: 1893–1900.Google Scholar
40. Lewis, CW, Carron, JD, Perkins, JA, Sie, KC, Feudtner, C. Tracheotomy in pediatric patients: a national perspective. Arch Otolaryngol Head Neck Surg 2003; 129: 523–529.Google Scholar
41. Patrick, SW, Schumacher, RE, Davis, MM. Variation in lumbar punctures for early onset neonatal sepsis: a nationally representative serial cross-sectional analysis, 2003-2009. BMC Pediatr 2012; 12: 134.Google Scholar
Supplementary material: Image

Weinberg supplementary material

Figure S1a

Download Weinberg supplementary material(Image)
Image 563.3 KB
Supplementary material: Image

Weinberg supplementary material

Figure S1b

Download Weinberg supplementary material(Image)
Image 547.6 KB
Supplementary material: Image

Weinberg supplementary material

Figure S2

Download Weinberg supplementary material(Image)
Image 1.4 MB
Supplementary material: Image

Weinberg supplementary material

Figure S3

Download Weinberg supplementary material(Image)
Image 587.8 KB
Supplementary material: File

Weinberg supplementary material

Table S1

Download Weinberg supplementary material(File)
File 18.6 KB
Supplementary material: File

Weinberg supplementary material

Table S2

Download Weinberg supplementary material(File)
File 17.3 KB
Supplementary material: File

Weinberg supplementary material

Table S3

Download Weinberg supplementary material(File)
File 15.7 KB