Effects of practice change on outcomes of extremely preterm infants with patent ductus arteriosus

Ezenwa, Beatrice Nkolika; Pena, E; Schlegel, Amy; Bapat, Roopali; Shepherd, Edward G.; Nelin, Leif D.

doi:10.1111/apa.14423

Cited by 16 publications

(7 citation statements)

References 29 publications

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“…In fact, 80% of patients in this high-risk group of EP patients from our small baby program from 2008 to 2014 had cognitive scores ≥80, >70% had communicative scores ≥80, and >60% had motor scores ≥80 on Bayley exams completed between 16 and 24 months (median 19 months). Even with an increase in survival during this time, the number of EP survivors with composite scores <80 did not increase [19]. A similar trend is highlighted when we evaluate BPD and neurodevelopmental outcomes, as the two have long been thought to be linked.…”

Section: Discussionsupporting

confidence: 62%

“…In 2010, our practice changed to significantly decrease the treatment of PDAs. In studying the EP infants admitted to the small baby program from 2008 to 2015, we found that decreasing the rates of PDA treatment was not associated with adverse effects on mortality or rates of BPD [19]. We also sought to change our culture and approach as it pertained to the initial extubation attempt.…”

Section: Discussionmentioning

confidence: 99%

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Development of a small baby unit to improve outcomes for the extremely premature infant

et al. 2021

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Survival and outcomes for extremely premature (EP) infants have improved and even infants born at 23 and 24 weeks that were previously considered non-viable are now routinely surviving. This review describes our particular institution's basis for and process of creating and sustaining a small baby program for a quaternary, referral-based neonatal intensive care unit. Through multidisciplinary collaboration, small baby guidelines were developed that established uniform care and optimized evidence-based practice for the care of this unique patient population. A focus on parent-centered care while removing noxious stimuli for the patient has improved neurodevelopmental outcomes. Data collection, quality improvement, and ongoing research are incorporated in the small baby program to establish and sustain best practices and outcomes for the EP patient. Through the establishment of a small baby unit, we have improved survival, decreased short-term morbidities, and improved neurodevelopmental outcomes for the EP infant in our region.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Development of a small baby unit to improve outcomes for the extremely premature infant

et al. 2021

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“…In a large population of infants at <30 weeks’ GA using the Pediatrix Clinical Data Warehouse in the United States, there were significant decreases PDA diagnosis and treatment from 2006 to 2015 [60]. The rationale for this change is due to the observation that active measures to close PDA did not decrease the mortality and major comorbidities in preterm infants [61-63] and that spontaneous ductal closure occurred in a substantial portion of infants, particularly in more mature infants, especially in infants with GA >29 weeks. For long-term neurodevelopmental outcomes, there are reports that PDA presence in moderately preterm, low birthweight infants does not impact long-term neurodevelopmental outcomes [64].…”

Section: Pda Treatment and Neonatal Outcomesmentioning

confidence: 99%

Practice for preterm patent ductus arteriosus; focusing on the hemodynamic significance and the impact on the neonatal outcomes

Lee

2019

Korean J Pediatr

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Hemodynamically significant preterm patent ductus arteriosus (PDA) affects mortality; comorbidities such as necrotizing enterocolitis, intraventricular hemorrhage, and bronchopulmonary dysplasia; and adverse long-term neurodevelopmental outcomes in preterm infants, particularly in very low birth weight infants. However, recent studies have indicated that there is no consensus on the causal relationship between PDA and neonatal outcomes, the benefit of PDA treatment, the factors guiding the need for treatment, and optimal treatment strategies. Such uncertainty has resulted in wide variations in practice for treating preterm PDA between units, regions, and nations. Nowadays, there has been a paradigm shift to more conservative treatment for preterm PDA, and suggestions regarding selective management of preterm PDA considering risk factors and hemodynamic significance are increasing. Neonatologist-performed echocardiography and advances in modalities to assess hemodynamic significance such as biologic markers and near-infrared spectroscopy also help improve the efficacy of selective treatment of preterm PDA.

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“…Chronic PDA will unfavorably affect the cardiopulmonary status of these infants, especially when the condition is hemodynamically significant. Hemodynamically significant PDA (hsPDA), usually diagnosed by a combination of clinical signs and echocardiogram, can cause leftto-right shunt associated with a series of complications, including congestive heart failure, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage, and necrotizing enterocolitis, any of which can affect the survival and prognosis of premature infants (1)(2)(3). The younger the gestational age of the infant at birth, the more likely the presence of PDA.…”

Section: Introductionmentioning

confidence: 99%

“…However, surgical ligation is still an important therapeutic option in premature infants who are contraindicated for medical treatment, or for whom medical treatment has failed. According to a study in Nationwide Children's Hospital, Columbus, the rate of PDA ligation decreased substantially since 2010 (1).…”

Section: Introductionmentioning

confidence: 99%

Age at Surgical Ligation of Patent Ductus Arteriosus Affects Prognosis in Extremely Premature Infants

Han

Yang

et al. 2021

Iran J Pediatr

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Background: This study aimed to evaluate outcomes, prognosis, and safety associated with the timing of surgical ligation for patent ductus arteriosus (PDA) in extremely premature infants (EPI). Methods: We reviewed the clinical data of 44 EPI (gestational age at birth 26.8 ± 0.67 weeks; birth weight 997 ± 152 g) who received surgical ligation for hemodynamically significant PDA (hsPDA) in the Neonatal Intensive Care Unit (NICU) of Bayi Children’s Hospital in China between January 2021 and December 2014. We compared the general characteristics, underlying diseases, postoperative surgical complications, and prognoses in two groups of patients who received early ligation (≤ 14 days after birth) and late ligation (> 14 days after birth). Results: The gender, gestational age at birth, birth weight, Apgar score, postoperative surgical complications, rates of bronchopulmonary dysplasia (BPD), retinopathy of prematurity, necrotic enterocolitis, periventricular leukomalacia, total hospitalization, and medical costs of both groups were compared. According to the results, the late ligation group had a higher rate of severe BPD (66.3% cf. 35%) and required significantly longer time to reach total enteral feeding and weaning of respiratory support compared with the early ligation group. Conclusions: In EPI with hsPDA, for whom medical treatment failed or is contraindicated, early surgical closure of the ductus arteriosus can promote earlier total enteral feeding, shorten the duration of mechanical ventilation, and reduce the rates of severe BPD.

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Effects of practice change on outcomes of extremely preterm infants with patent ductus arteriosus

Abstract: In this cohort of EP patients, the rate of PDA ligation decreased substantially since 2010, with no apparent adverse effects on mortality or rates of BPD. These data are consistent with the concept that ligation does not improve outcomes in EP infants.

Cited by 16 publications

References 29 publications

Development of a small baby unit to improve outcomes for the extremely premature infant

Development of a small baby unit to improve outcomes for the extremely premature infant

Practice for preterm patent ductus arteriosus; focusing on the hemodynamic significance and the impact on the neonatal outcomes

Age at Surgical Ligation of Patent Ductus Arteriosus Affects Prognosis in Extremely Premature Infants

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