Current Trends in Invasive Closure of Patent Ductus Arteriosus in Very Low Birth Weight Infants in United States Children's Hospitals, 2016-2021

Kuan-Chi Lai; Troy Richardson; Darren Berman; Sara B DeMauro; Brian C King; Joanne Lagatta; Henry C Lee; Tamorah Lewis; Shahab Noori; Michael L O'Byrne; Ravi M Patel; Jonathan L Slaughter; Ashwini Lakshmanan

doi:10.1016/j.jpeds.2023.113712

Current Trends in Invasive Closure of Patent Ductus Arteriosus in Very Low Birth Weight Infants in United States Children's Hospitals, 2016-2021

J Pediatr. 2023 Dec:263:113712. doi: 10.1016/j.jpeds.2023.113712. Epub 2023 Sep 1.

Authors

Affiliations

¹ Division of Neonatology, Children's Hospital Los Angeles and University of Southern California, Los Angeles, CA. Electronic address: kclai@chla.usc.edu.
² Children's Hospital Association, Lenexa, KS.
³ Division of Cardiology, Children's Hospital Los Angeles and University of Southern California, Los Angeles, CA.
⁴ Division of Neonatology, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA.
⁵ Division of Newborn Medicine, UPMC Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, PA.
⁶ Division of Neonatology, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, WI.
⁷ Division of Neonatology, Rady Children's Hospital and University of California San Diego, San Diego, CA.
⁸ Division of Neonatology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
⁹ Division of Neonatology, Children's Hospital Los Angeles and University of Southern California, Los Angeles, CA.
¹⁰ Division of Cardiology, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA.
¹¹ Division of Neonatology, Children's Healthcare of Atlanta and Emory University, Atlanta, GA.
¹² Division of Neonatology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH.
¹³ Division of Neonatology, Children's Hospital Los Angeles and University of Southern California, Los Angeles, CA; Department of Health Systems Science, Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, CA.

PMID: 37659587
DOI: 10.1016/j.jpeds.2023.113712

Abstract

Objective: To describe the current practices in invasive patent ductus arteriosus (PDA) closure (surgical ligation or transcatheter occlusion) in very low birth weight (VLBW) infants and changes in patient characteristics and outcomes from 2016 to 2021 among US children's hospitals.

Study design: We evaluated a retrospective cohort of VLBW infants (birth weight 400-1499 g and gestational age 22-31 weeks) who had invasive PDA closure within 6 months of age from 2016 to 2021 in children's hospitals in the Pediatric Health Information System. Changes in patient characteristics and outcomes over time were evaluated using generalized linear models and generalized linear mixed models.

Results: 2418 VLBW infants (1182 surgical ligation; 1236 transcatheter occlusion) from 42 hospitals were included. The proportion of infants receiving transcatheter occlusion increased from 17.2% in 2016 to 84.4% in 2021 (P < .001). In 2021, 28/42 (67%) hospitals had performed transcatheter occlusion in > 80% of their VLBW infants needing invasive PDA closure, compared with only 2/42 (5%) in 2016. Although median postmenstrual age (PMA) at PDA closure did not change for the overall cohort, PMA at transcatheter occlusion decreased from 38 weeks in 2016 to 31 weeks by 2020, P < .001. Among those infants not intubated prior to PDA closure, extubation within 3 days postprocedure increased over time (yearly adjusted odds ratios of 1.26 [1.08-1.48]). Length of stay and mortality did not change over time.

Conclusion: We report rapid adoption of transcatheter occlusion for PDA among VLBW infants in US children's hospitals over time. Transcatheter occlusions were performed at younger PMA over time.

Keywords: patent ductus arteriosus; surgical ligation; transcatheter occlusion; very low birth weight infants.

MeSH terms

Birth Weight
Child
Ductus Arteriosus, Patent* / surgery
Humans
Infant
Infant, Newborn
Infant, Very Low Birth Weight
Retrospective Studies
Treatment Outcome
United States