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- Isayama, Tetsuya (author)
Neonatal Intensive Care Unit-Level Patent Ductus Arteriosus Treatment Rates and Outcomes in Infants Born Extremely Preterm
- Article/chapterEnglish2020
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- Elsevier,2020
- printrdacarrier
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- LIBRIS-ID:oai:DiVA.org:umu-173848
- https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-173848URI
- https://doi.org/10.1016/j.jpeds.2020.01.069DOI
- http://kipublications.ki.se/Default.aspx?queryparsed=id:143797234URI
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- Language:English
- Summary in:English
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- Objectives: To assess associations between neonatal intensive care unit (NICU)- level patent ductus arteriosus (PDA) treatment rates (pharmacologic or surgical) and neonatal outcomes.Study design: This cohort study included infants born at 24-28 weeks of gestation and birth weight <1500 g in 2007-2015 in NICUs caring for >= 100 eligible infants in 6 countries. The ratio of observed/expected (O/E) PDA treatment rates was derived for each NICU by estimating the expected rate using a logistic regression model adjusted for potential confounders and network. The primary composite outcome was death or severe neurologic injury (grades III-IV intraventricular hemorrhage or periventricular leukomalacia). The associations between the NICU-level O/E PDA treatment ratio and neonatal outcomes were assessed using linear regression analyses including a quadratic effect (a square term) of the O/E PDA treatment ratio.Results: From 139 NICUs, 39 096 infants were included. The overall PDA treatment rate was 45% in the cohort (13%-77% by NICU) and the O/E PDA treatment ratio ranged from 0.30 to 2.14. The relationship between the O/E PDA treatment ratio and primary composite outcome was U-shaped, with the nadir at a ratio of 1.13 and a significant quadratic effect (P<.001). U-shaped relationships were also identified with death, severe neurologic injury, and necrotizing enterocolitis.Conclusions: Both low and high PDA treatment rates were associated with death or severe neurologic injury, whereas a moderate approach was associated with optimal outcomes.
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- Kusuda, Satoshi (author)
- Reichman, Brian (author)
- Lee, Shoo K. (author)
- Lehtonen, Liisa (author)
- Norman, MikaelKarolinska Institutet (author)
- Adams, Mark (author)
- Bassler, Dirk (author)
- Helenius, Kjell (author)
- Håkansson, StellanUmeå universitet,Pediatrik(Swepub:umu)stha0034 (author)
- Yang, Junmin (author)
- Jain, Amish (author)
- Shah, Prakesh S. (author)
- Karolinska InstitutetPediatrik (creator_code:org_t)
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- In:Journal of Pediatrics: Elsevier220, s. 34-39.e050022-34761097-6833
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