Therapeutic strategies, including a high surgical ligation rate, for patent ductus arteriosus closure in extremely premature infants in a North American centre

Moore, Gregory P.; Lawrence, Sarah; Maharajh, Gyaandeo; Sumner, Amanda; Gaboury, Isabelle; Barrowman, Nick; Lemyre, Brigitte

doi:10.1093/pch/17.4.e26

Cited by 10 publications

(10 citation statements)

References 31 publications

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“…Six authors provided additional data or analyses not included in their original publication. 8,[30][31][32][33][34] Baseline characteristics of the 40 studies included 8,10,11, (39 cohort studies and 1 RCT), encompassing 32 345 preterm infants, are reported in Table 1.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Eleven cohort studies performed multivariate analyses. Data from 9 of these studies 8,10,11,30,33,51,58,63,64 and the RCT 35 were combined in meta-analyses of multivariate results. Data from 2 cohort studies 32,34 could not be pooled because of insufficient information to interpret the adjusted results.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Most IVH (90%) occurs in the first week of life, 166 preceding the timing of surgical ligation reported in most studies. 33,45,48,50,59 Other potential key confounders include prolonged duration of mechanical ventilation, severe hypotension, postnatal sepsis, and NEC, which increase illness severity but are also associated with PDA ligation, death, NDI, CLD, and ROP. [167][168][169][170][171][172][173][174][175] These morbidities, however, can occur before, during, or after PDA treatments and thus may be considered confounders in some infants and outcomes in others.…”

Section: Figurementioning

confidence: 99%

“…Only 1 study controlled for postnatal sepsis, 10 a known risk factor for CLD, 184 and this study did not differentiate between sepsis that occurred before or after surgical ligation. In addition, ventilator dependence is commonly considered an indication for ligation in infants in whom medical therapy had failed or was contraindicated, 33,44,47,48,62 and yet it is also a risk factor for CLD. 185 Given the association between CLD and ROP and death or NDI, 181,182,186 it is important, when analyzing these outcomes, to adjust for preligation respiratory morbidity.…”

Section: Figurementioning

confidence: 99%

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PDA Ligation and Health Outcomes: A Meta-analysis

et al. 2014

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BACKGROUND AND OBJECTIVE: Patent ductus arteriosus (PDA) ligation has been variably associated with neonatal morbidities and neurodevelopmental impairment (NDI). The objective was to systematically review and meta-analyze the impact of PDA ligation in preterm infants at <32 weeks’ gestation on the risk of mortality, severe neonatal morbidities, and NDI in early childhood. METHODS: Medline, Embase, Cochrane Central Register of Controlled Trials, Education Resources Information Centre (ERIC), Cumulative Index to Nursing and Allied Health (CINAHL), PsycINFO, and the Dissertation database were searched (1947 through August 2013). Risk of bias was assessed by using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool. Meta-analyses were performed by using a random-effects model. Unadjusted and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were pooled when appropriate. RESULTS: Thirty-nine cohort studies and 1 randomized controlled trial were included. Nearly all cohort studies had at least moderate risk of bias mainly due to failure to adjust for survival bias and important postnatal preligation confounders such as ventilator dependence, intraventricular hemorrhage, and sepsis. Compared with medical treatment, surgical ligation was associated with increases in NDI (aOR: 1.54; 95% CI: 1.01–2.33), chronic lung disease (aOR: 2.51; 95% CI: 1.98–3.18), and severe retinopathy of prematurity (aOR: 2.23; 95% CI: 1.62–3.08) but with a reduction in mortality (aOR: 0.54; 95% CI: 0.38–0.77). There was no difference in the composite outcome of death or NDI in early childhood (aOR: 0.95; 95% CI: 0.58–1.57). CONCLUSIONS: Surgical ligation of PDA is associated with reduced mortality, but surviving infants are at increased risk of NDI. However, there is a lack of studies addressing survival bias and confounding by indication.

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Section: Description Of Studiesmentioning

confidence: 99%

Section: Description Of Studiesmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

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PDA Ligation and Health Outcomes: A Meta-analysis

et al. 2014

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“…A recent study from Australia showed that a second course of indomethacin rarely led to PDA closure [15]. Moore et al retrospectively studied infants <27 weeks of gestation over a 12-year period and noted <30 % successful PDA closure after the first course of indomethacin; the majority of infants receiving greater than one course underwent surgical ligation [19]. Other studies have noted higher closure rates (66 % with indomethacin vs 70 % with ibuprofen); treatment was initiated early, median 3 days [34].…”

Section: Discussionmentioning

confidence: 99%