Covariation of Neonatal Intensive Care Unit-Level Patent Ductus Arteriosus Management and In-Neonatal Intensive Care Unit Outcomes Following Preterm Birth

J Pediatr. 2018 Dec:203:225-233.e1. doi: 10.1016/j.jpeds.2018.07.025. Epub 2018 Sep 20.

Abstract

Objective: To test the hypothesis that neonatal intensive care unit (NICU)-specific changes in patent ductus arteriosus (PDA) management are associated with changes in local outcomes in preterm infants.

Study design: This retrospective repeated-measures study of aggregated data included infants born 400-1499 g admitted within 2 days of delivery to NICUs participating in the California Perinatal Quality Care Collaborative. The period 2008-2015 was divided into four 2-year epochs. For each epoch and NICU, we calculated proportions of infants receiving cyclooxygenase inhibitor (COXI) or PDA ligation and determined NICU-specific changes in these therapies between consecutive epochs. Generalized estimating equations were used to examine adjusted relationships between NICU-specific changes in PDA management and contemporaneous changes in local outcomes.

Results: We included 642 observations of interepoch change at 119 hospitals summarizing 32 094 infants. NICU-specific changes in COXI use and ligation showed significant dose-response associations with contemporaneous changes in adjusted local outcomes. Each percentage point decrease in NICU-specific proportion treated with either COXI or ligation was associated with a 0.21 percentage point contemporaneous increase in adjusted local in-hospital mortality (95% CI 0.06, 0.33; P = .005) among infants born 400-749 g. In contrast, decreasing NICU-specific ligation rate among infants 1000-1499 g was associated with decreasing adjusted local bronchopulmonary dysplasia (P = .009) and death or bronchopulmonary dysplasia (P = .01).

Conclusions: NICU-specific outcomes of preterm birth co-vary with local PDA management. Treatment for PDA closure may benefit some infants born 400-749 g. Decreasing NICU-specific rates of COXI use or ligation were not associated with increases in local adjusted rates of examined adverse outcomes in larger preterm infants.

Keywords: bronchopulmonary dysplasia; epidemiology; infant; mortality; newborn; prematurity.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Bronchopulmonary Dysplasia / diagnostic imaging
  • Bronchopulmonary Dysplasia / mortality*
  • Bronchopulmonary Dysplasia / therapy
  • California
  • Cause of Death
  • Cohort Studies
  • Cyclooxygenase Inhibitors / therapeutic use
  • Ductus Arteriosus, Patent / diagnostic imaging
  • Ductus Arteriosus, Patent / mortality*
  • Ductus Arteriosus, Patent / therapy*
  • Female
  • Hospital Mortality*
  • Humans
  • Infant, Newborn
  • Intensive Care Units, Neonatal / organization & administration*
  • Ligation / methods
  • Male
  • Multivariate Analysis
  • Outcome Assessment, Health Care
  • Pregnancy
  • Premature Birth*
  • Retrospective Studies
  • Risk Assessment
  • Survival Analysis
  • Treatment Outcome

Substances

  • Cyclooxygenase Inhibitors