Effects of practice change on outcomes of extremely preterm infants with patent ductus arteriosus.
AIM
To determine whether a decrease in patent ductus arteriosus (PDA) treatment or ligation in extremely preterm (EP) infants was associated with changes in rates of mortality and/or morbidities.


METHODS
Observational study on EP infants admitted from 2008 to 2015. The small baby guidelines do not mandate ligation, however, in late 2010 the guidelines were amended based on new literature suggested that ligation may increase rates of morbidities.


RESULTS
There were 717 EP infants admitted during the study period. There were no significant changes in gestational age, birthweight or annual admissions during the study period. The annual rate of PDA medical treatment declined significantly (R = 0.83, p = 0.01), while the annual rate of PDA ligation declined substantially (R = 0.88, p = 0.004). The annual mortality rate also declined significantly (R = 0.81, p = 0.014). The annual rates of bronchopulmonary dysplasia (BPD), necrotising enterocolitis and intraventricular haemorrhage did not change significantly.


CONCLUSION
In this cohort of EP patients, the rate of PDA ligation decreased substantially since 2010, with no apparent adverse effects on mortality or rates of BPD. These data are consistent with the concept that ligation does not improve outcomes in EP infants.
['Ezenwa|B|B|', 'Pena|E|E|', 'Schlegel|A|A|', 'Bapat|R|R|', 'Shepherd|E G|EG|', 'Nelin|L D|LD|0000-0002-3722-3035']
D015331:Cohort Studies D000072700:Conservative Treatment D016861:Cyclooxygenase Inhibitors D016208:Databases, Factual D004374:Ductus Arteriosus, Patent D005260:Female D005500:Follow-Up Studies D005865:Gestational Age D017052:Hospital Mortality D006801:Humans D062071:Infant, Extremely Premature D007231:Infant, Newborn D007363:Intensive Care Units, Neonatal D053208:Kaplan-Meier Estimate D008026:Ligation D016015:Logistic Models D008297:Male D010818:Practice Patterns, Physicians' D011379:Prognosis D012189:Retrospective Studies D018570:Risk Assessment D016896:Treatment Outcome
Extremely preterm infant Bronchopulmonary dysplasia Neurodevelopmental outcome