1. Outcomes for Infants Born in Perinatal Centers Performing Fewer Surgical Ligations for Patent Ductus Arteriosus: A Swiss Population-Based Study
- Author
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Mark Adams, Sven M. Schulzke, Giancarlo Natalucci, Juliane Schneider, Thomas Riedel, Cristina Borradori Tolsa, Riccardo Pfister, Dirk Bassler, Philipp Meyer, Rachel Kusche, Andrea Capone Mori, Daniela Kaeppeli, Marc Brotzmann, Gian Paolo Ramelli, Barbara Simonetti Goeggel, Jane McDougall, Tilman Humpl, Maja Steinlin, Sebastian Grunt, Mathias Gebauer, Ralph Hassink, Elmar Keller, Christa Killer, Gaelle Blanchard, Riccardo E. Pfister, Petra S. Huppi, Cristina Borradori-Tolsa, Jean-François Tolsa, Matthias Roth-Kleiner, Myriam Bickle-Graz, Martin Stocker, Thomas Schmitt-Mechelke, Florian Bauder, Bernd Erkert, Anita Mueller, Marc Ecoffey, Andreas Malzacher, Bjarte Rogdo, Anette Lang-Dullenkopf, Lukas Hegi, Michael von Rhein, Vera Bernet, Maren Tomaske, Romaine Arlettaz, Cornelia Hagmann, Bea Latal, Ruth Etter, University of Zurich, and Adams, Mark
- Subjects
Male ,Pediatrics ,Infant, Premature, Diseases ,Kaplan-Meier Estimate ,0302 clinical medicine ,Ductus arteriosus ,Odds Ratio ,030212 general & internal medicine ,Patent ductus arteriosus ligation ,Ductus Arteriosus, Patent ,education.field_of_study ,ddc:618 ,Perinatology ,Hospitalization ,Survival Rate ,and Child Health ,medicine.anatomical_structure ,Treatment Outcome ,Necrotizing enterocolitis ,Cohort ,Gestation ,Female ,Infant, Premature ,Switzerland ,medicine.medical_specialty ,Population ,Extremely preterm ,610 Medicine & health ,Sepsis ,03 medical and health sciences ,030225 pediatrics ,medicine ,Humans ,2735 Pediatrics, Perinatology and Child Health ,Mortality ,education ,Propensity Score ,Ligation ,Retrospective Studies ,Morbidities ,business.industry ,Infant, Newborn ,Retrospective cohort study ,medicine.disease ,10027 Clinic for Neonatology ,Neurodevelopmental impairment ,Logistic Models ,10036 Medical Clinic ,Pediatrics, Perinatology and Child Health ,Propensity score matching ,business ,Procedures and Techniques Utilization - Abstract
Objective To assess patent ductus arteriosus treatment variation between Swiss perinatal centers and to determine its effect on outcome in a population-based setting. Study design This was a retrospective cohort study of infants born less than 28 weeks of gestation between 2012 and 2017. Outcomes between surgically ligated and pharmacologically treated infants as well as infants born in centers performing ≤10% ligation (“low” group) and >10% (“high” group) were compared using logistic regression and 1:1 propensity score matching. Matching was based on case-mix and preligation confounders: intraventricular hemorrhages grades 3-4, necrotizing enterocolitis, sepsis, and ≥28 days’ oxygen supply. Results Of 1389 infants, 722 (52%) had pharmacologic treatment and 156 (11.2%) received surgical ligation. Compared with infants who received pharmacologic treatment, ligated infants had greater odds for major morbidities (OR 2.09, 95% CI 1.44-3.04) and 2-year neurodevelopmental impairment (OR 1.81, 95% CI 1.15-2.84). Mortality was comparable after restricting the cohort to infants surviving at least until day 10 to avoid survival bias. In the “low” group, 34 (4.9%) of 696 infants were ligated compared with 122 (17.6%) of 693 infants in the “high” group. Infants in the “high” group had greater odds for major morbidities (OR 1.49, 95% CI 1.11-2.0). Conclusions Our analysis identified a burden on infants receiving surgical ligation vs pharmacologic treatment in a population-based setting where there was no agreed-on common procedure. These results may guide a revision of patent ductus arteriosus treatment practice in Switzerland.
- Published
- 2021