Neonatal Intensive Care Unit-Level Patent Ductus Arteriosus Treatment Rates and Outcomes in Infants Born Extremely Preterm

Tetsuya Isayama; Satoshi Kusuda; Brian Reichman; Shoo K. Lee; Liisa Lehtonen; Mikael Norman; Mark Adams; Dirk Bassler; Kjell Helenius; Stellan Hakansson; Junmin Yang; Amish Jain; Prakesh S. Shah; Adele Harrison; Anne Synnes; Joseph Ting; Zenon Cieslak; Rebecca Sherlock; Wendy Yee; Khalid Aziz; Jennifer Toye; Carlos Fajardo; Zarin Kalapesi; Koravangattu Sankaran; Sibasis Daspal; Mary Seshia; Ruben Alvaro; Amit Mukerji; Orlando Da Silva; Chuks Nwaesei; Kyong Soon Lee; Michael Dunn; Brigitte Lemyre; Kimberly Dow; Ermelinda Pelausa; Keith Barrington; Christine Drolet; Bruno Piedboeuf; Martine Claveau; Marc Beltempo; Valerie Bertelle; Edith Masse; Roderick Canning; Hala Makary; Cecil Ojah; Luis Monterrosa; Akhil Deshpandey; Jehier Afifi; Andrzej Kajetanowicz; Sture Andersson; Outi Tammela; Ulla Sankilampi; Timo Saarela; Eli Heymann; Shmuel Zangen; Tatyana Smolkin; Francis Mimouni; David Bader; Avi Rothschild; Zipora Strauss; Clari Felszer; Hussam Omari; Smadar Even Tov-Friedman; Benjamin Bar-Oz; Michael Feldman; Nizar Saad; Orna Flidel-Rimon; Meir Weisbrod; Daniel Lubin; Ita Litmanovitz; Amir Kugelman; Eric Shinwell; Gil Klinger; Yousif Nijim; Alona Bin-Nun; Agneta Golan; Dror Mandel; Vered Fleisher-Sheffer; David Kohelet; Lev Bakhrakh; Satoshi Hattori; Masaru Shirai; Toru Ishioka; Toshihiko Mori; Takasuke Amizuka; Toru Huchimukai; Hiroshi Yoshida; Ayako Sasaki; Junichi Shimizu; Toshihiko Nakamura; Mami Maruyama; Hiroshi Matsumoto; Shinichi Hosokawa; Atsuko Taki; Machiko Nakagawa; Kyone Ko; Azusa Uozumi; Setsuko Nakata; Akira Shimazaki; Tatsuya Yoda; Osamu Numata; Hiroaki Imamura; Azusa Kobayashi; Shuko Tokuriki; Yasushi Uchida; Takahiro Arai; Mitsuhiro Ito; Kuniko Ieda; Toshiyuki Ono; Masashi Hayashi; Kanemasa Maki; Mie Toru Yamakawa; Masahiko Kawai; Noriko Fujii; Kozue Shiomi; Koji Nozaki; Hiroshi Wada; Taho Kim; Yasuyuki Tokunaga; Akihiro Takatera; Toshio Oshima; Hiroshi Sumida; Yae Michinomae; Yoshio Kusumoto; Seiji Yoshimoto; Takeshi Morisawa; Tamaki Ohashi; Yukihiro Takahashi; Moriharu Sugimoto; Noriaki Ono; Shinichiro Miyagawa; Takahiko Saijo; Takashi Yamagami; Kosuke Koyano; Shoko Kobayashi; Takeshi Kanda; Yoshihiro Sakemi; Mikio Aoki; Koichi Iida; Mitsushi Goshi; Yuko Maruyama; Jiri Kofron; Katarina Strand Brodd; Andreas Odlind; Lars Alberg; Sofia Arwehed; Ola Hafström; Anna Kasemo; Karin Nederman; Lars Åhman; Fredrik Ingemarsson; Henrik Petersson; Pernilla Thurn; Eva Albinsson; Bo Selander; Thomas Abrahamsson; Ingela Heimdahl; Kristbjorg Sveinsdottir; Erik Wejryd; Anna Hedlund; Maria Katarina Söderberg; Lars Navér; Thomas Brune; Jens Bäckström; Johan Robinson; Aijaz Farooqi; Erik Normann; Magnus Fredriksson; Anders Palm; Urban Rosenqvist; Bengt Walde; Cecilia Hagman; Andreas Ohlin; Rein Florell; Agneta Smedsaas Löfvenberg; Philipp Meyer; Rachel Kusche; Sven Schulzke; Mathias Nelle; Bendicht Wagner; Thomas Riedel; Grégoire Kaczala; Riccardo E. Pfister; Jean François Tolsa; Matthias Roth; Martin Stocker; Bernhard Laubscher; Andreas Malzacher; John P. Micallef; Lukas Hegi; Romaine Arlettaz; Vera Bernet

doi:10.1016/j.jpeds.2020.01.069

Neonatal Intensive Care Unit-Level Patent Ductus Arteriosus Treatment Rates and Outcomes in Infants Born Extremely Preterm

Tetsuya Isayama, Satoshi Kusuda, Brian Reichman, Shoo K. Lee, Liisa Lehtonen, Mikael Norman, Mark Adams, Dirk Bassler, Kjell Helenius, Stellan Hakansson, Junmin Yang, Amish Jain, Prakesh S. Shah, Adele Harrison, Anne Synnes, Joseph Ting, Zenon Cieslak, Rebecca Sherlock, Wendy Yee, Khalid AzizJennifer Toye, Carlos Fajardo, Zarin Kalapesi, Koravangattu Sankaran, Sibasis Daspal, Mary Seshia, Ruben Alvaro, Amit Mukerji, Orlando Da Silva, Chuks Nwaesei, Kyong Soon Lee, Michael Dunn, Brigitte Lemyre, Kimberly Dow, Ermelinda Pelausa, Keith Barrington, Christine Drolet, Bruno Piedboeuf, Martine Claveau, Marc Beltempo, Valerie Bertelle, Edith Masse, Roderick Canning, Hala Makary, Cecil Ojah, Luis Monterrosa, Akhil Deshpandey, Jehier Afifi, Andrzej Kajetanowicz, Sture Andersson, Outi Tammela, Ulla Sankilampi, Timo Saarela, Eli Heymann, Shmuel Zangen, Tatyana Smolkin, Francis Mimouni, David Bader, Avi Rothschild, Zipora Strauss, Clari Felszer, Hussam Omari, Smadar Even Tov-Friedman, Benjamin Bar-Oz, Michael Feldman, Nizar Saad, Orna Flidel-Rimon, Meir Weisbrod, Daniel Lubin, Ita Litmanovitz, Amir Kugelman, Eric Shinwell, Gil Klinger, Yousif Nijim, Alona Bin-Nun, Agneta Golan, Dror Mandel, Vered Fleisher-Sheffer, David Kohelet, Lev Bakhrakh, Satoshi Hattori, Masaru Shirai, Toru Ishioka, Toshihiko Mori, Takasuke Amizuka, Toru Huchimukai, Hiroshi Yoshida, Ayako Sasaki, Junichi Shimizu, Toshihiko Nakamura, Mami Maruyama, Hiroshi Matsumoto, Shinichi Hosokawa, Atsuko Taki, Machiko Nakagawa, Kyone Ko, Azusa Uozumi, Setsuko Nakata, Akira Shimazaki, Tatsuya Yoda, Osamu Numata, Hiroaki Imamura, Azusa Kobayashi, Shuko Tokuriki, Yasushi Uchida, Takahiro Arai, Mitsuhiro Ito, Kuniko Ieda, Toshiyuki Ono, Masashi Hayashi, Kanemasa Maki, Mie Toru Yamakawa, Masahiko Kawai, Noriko Fujii, Kozue Shiomi, Koji Nozaki, Hiroshi Wada, Taho Kim, Yasuyuki Tokunaga, Akihiro Takatera, Toshio Oshima, Hiroshi Sumida, Yae Michinomae, Yoshio Kusumoto, Seiji Yoshimoto, Takeshi Morisawa, Tamaki Ohashi, Yukihiro Takahashi, Moriharu Sugimoto, Noriaki Ono, Shinichiro Miyagawa, Takahiko Saijo, Takashi Yamagami, Kosuke Koyano, Shoko Kobayashi, Takeshi Kanda, Yoshihiro Sakemi, Mikio Aoki, Koichi Iida, Mitsushi Goshi, Yuko Maruyama, Jiri Kofron, Katarina Strand Brodd, Andreas Odlind, Lars Alberg, Sofia Arwehed, Ola Hafström, Anna Kasemo, Karin Nederman, Lars Åhman, Fredrik Ingemarsson, Henrik Petersson, Pernilla Thurn, Eva Albinsson, Bo Selander, Thomas Abrahamsson, Ingela Heimdahl, Kristbjorg Sveinsdottir, Erik Wejryd, Anna Hedlund, Maria Katarina Söderberg, Lars Navér, Thomas Brune, Jens Bäckström, Johan Robinson, Aijaz Farooqi, Erik Normann, Magnus Fredriksson, Anders Palm, Urban Rosenqvist, Bengt Walde, Cecilia Hagman, Andreas Ohlin, Rein Florell, Agneta Smedsaas Löfvenberg, Philipp Meyer, Rachel Kusche, Sven Schulzke, Mathias Nelle, Bendicht Wagner, Thomas Riedel, Grégoire Kaczala, Riccardo E. Pfister, Jean François Tolsa, Matthias Roth, Martin Stocker, Bernhard Laubscher, Andreas Malzacher, John P. Micallef, Lukas Hegi, Romaine Arlettaz, Vera Bernet

Medicine

Research output: Contribution to journal › Article › peer-review

26 Citations (Scopus)

Abstract

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.

Original language	English
Pages (from-to)	34-39.e5
Journal	Journal of Pediatrics
Volume	220
DOIs	https://doi.org/10.1016/j.jpeds.2020.01.069
Publication status	Published - May 2020

Bibliographical note

Funding Information:
Funding and Conflicts of Interest Disclosure: Funding for iNeo was provided by a Canadian Institutes of Health Research Chair in Reproductive and Child Health Services and Policy Research (APR-126340 [to P.S.]). The Canadian Neonatal Network is supported by a team grant from the Canadian Institutes of Health Research (CTP 87518), the Ontario Ministry of Health and Long-Term Care , and the participating centers. The Finnish Medical Birth Register is governmentally funded and kept by the National Institute for Health and Welfare (THL). The Israel Neonatal Network very low birth weight infant database is partly funded by the Israel Center for Disease Control and the Ministry of Health . The Neonatal Research Network of Japan is partly funded by a Health Labour Sciences Research Grant from the Ministry of Health, Labour and Welfare of Japan. The Swedish Neonatal Quality Register is funded by the Swedish Government ( Ministry of Health and Social Affairs, Sweden ), the body of regional health care providers (County Councils), and the participating units. The Swiss Neonatal Network is partly funded by participating units in the form of membership fees. The funders played no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the writing, review, or approval of the manuscript; or the decision to submit the manuscript for publication. The authors declare no conflicts of interest.

Funding Information:
Funding and Conflicts of Interest Disclosure: Funding for iNeo was provided by a Canadian Institutes of Health Research Chair in Reproductive and Child Health Services and Policy Research (APR-126340 [to P.S.]). The Canadian Neonatal Network is supported by a team grant from the Canadian Institutes of Health Research (CTP 87518), the Ontario Ministry of Health and Long-Term Care, and the participating centers. The Finnish Medical Birth Register is governmentally funded and kept by the National Institute for Health and Welfare (THL). The Israel Neonatal Network very low birth weight infant database is partly funded by the Israel Center for Disease Control and the Ministry of Health. The Neonatal Research Network of Japan is partly funded by a Health Labour Sciences Research Grant from the Ministry of Health, Labour and Welfare of Japan. The Swedish Neonatal Quality Register is funded by the Swedish Government (Ministry of Health and Social Affairs, Sweden), the body of regional health care providers (County Councils), and the participating units. The Swiss Neonatal Network is partly funded by participating units in the form of membership fees. The funders played no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the writing, review, or approval of the manuscript; or the decision to submit the manuscript for publication. The authors declare no conflicts of interest. Funding and conflict of interest statements available in the Appendix (www.jpeds.com).

Publisher Copyright:
© 2020 Elsevier Inc.

ASJC Scopus Subject Areas

Pediatrics, Perinatology, and Child Health

Access to Document

10.1016/j.jpeds.2020.01.069

Cite this

Isayama, T., Kusuda, S., Reichman, B., Lee, S. K., Lehtonen, L., Norman, M., Adams, M., Bassler, D., Helenius, K., Hakansson, S., Yang, J., Jain, A., Shah, P. S., Harrison, A., Synnes, A., Ting, J., Cieslak, Z., Sherlock, R., Yee, W., ... Bernet, V. (2020). Neonatal Intensive Care Unit-Level Patent Ductus Arteriosus Treatment Rates and Outcomes in Infants Born Extremely Preterm. Journal of Pediatrics, 220, 34-39.e5. https://doi.org/10.1016/j.jpeds.2020.01.069

Isayama, T, Kusuda, S, Reichman, B, Lee, SK, Lehtonen, L, Norman, M, Adams, M, Bassler, D, Helenius, K, Hakansson, S, Yang, J, Jain, A, Shah, PS, Harrison, A, Synnes, A, Ting, J, Cieslak, Z, Sherlock, R, Yee, W, Aziz, K, Toye, J, Fajardo, C, Kalapesi, Z, Sankaran, K, Daspal, S, Seshia, M, Alvaro, R, Mukerji, A, Da Silva, O, Nwaesei, C, Lee, KS, Dunn, M, Lemyre, B, Dow, K, Pelausa, E, Barrington, K, Drolet, C, Piedboeuf, B, Claveau, M, Beltempo, M, Bertelle, V, Masse, E, Canning, R, Makary, H, Ojah, C, Monterrosa, L, Deshpandey, A, Afifi, J, Kajetanowicz, A, Andersson, S, Tammela, O, Sankilampi, U, Saarela, T, Heymann, E, Zangen, S, Smolkin, T, Mimouni, F, Bader, D, Rothschild, A, Strauss, Z, Felszer, C, Omari, H, Tov-Friedman, SE, Bar-Oz, B, Feldman, M, Saad, N, Flidel-Rimon, O, Weisbrod, M, Lubin, D, Litmanovitz, I, Kugelman, A, Shinwell, E, Klinger, G, Nijim, Y, Bin-Nun, A, Golan, A, Mandel, D, Fleisher-Sheffer, V, Kohelet, D, Bakhrakh, L, Hattori, S, Shirai, M, Ishioka, T, Mori, T, Amizuka, T, Huchimukai, T, Yoshida, H, Sasaki, A, Shimizu, J, Nakamura, T, Maruyama, M, Matsumoto, H, Hosokawa, S, Taki, A, Nakagawa, M, Ko, K, Uozumi, A, Nakata, S, Shimazaki, A, Yoda, T, Numata, O, Imamura, H, Kobayashi, A, Tokuriki, S, Uchida, Y, Arai, T, Ito, M, Ieda, K, Ono, T, Hayashi, M, Maki, K, Yamakawa, MT, Kawai, M, Fujii, N, Shiomi, K, Nozaki, K, Wada, H, Kim, T, Tokunaga, Y, Takatera, A, Oshima, T, Sumida, H, Michinomae, Y, Kusumoto, Y, Yoshimoto, S, Morisawa, T, Ohashi, T, Takahashi, Y, Sugimoto, M, Ono, N, Miyagawa, S, Saijo, T, Yamagami, T, Koyano, K, Kobayashi, S, Kanda, T, Sakemi, Y, Aoki, M, Iida, K, Goshi, M, Maruyama, Y, Kofron, J, Brodd, KS, Odlind, A, Alberg, L, Arwehed, S, Hafström, O, Kasemo, A, Nederman, K, Åhman, L, Ingemarsson, F, Petersson, H, Thurn, P, Albinsson, E, Selander, B, Abrahamsson, T, Heimdahl, I, Sveinsdottir, K, Wejryd, E, Hedlund, A, Söderberg, MK, Navér, L, Brune, T, Bäckström, J, Robinson, J, Farooqi, A, Normann, E, Fredriksson, M, Palm, A, Rosenqvist, U, Walde, B, Hagman, C, Ohlin, A, Florell, R, Löfvenberg, AS, Meyer, P, Kusche, R, Schulzke, S, Nelle, M, Wagner, B, Riedel, T, Kaczala, G, Pfister, RE, Tolsa, JF, Roth, M, Stocker, M, Laubscher, B, Malzacher, A, Micallef, JP, Hegi, L, Arlettaz, R & Bernet, V 2020, 'Neonatal Intensive Care Unit-Level Patent Ductus Arteriosus Treatment Rates and Outcomes in Infants Born Extremely Preterm', Journal of Pediatrics, vol. 220, pp. 34-39.e5. https://doi.org/10.1016/j.jpeds.2020.01.069

@article{48cc706de3554aa794fbd141780ffe0c,

title = "Neonatal Intensive Care Unit-Level Patent Ductus Arteriosus Treatment Rates and Outcomes in Infants Born Extremely Preterm",

abstract = "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.",

author = "Tetsuya Isayama and Satoshi Kusuda and Brian Reichman and Lee, {Shoo K.} and Liisa Lehtonen and Mikael Norman and Mark Adams and Dirk Bassler and Kjell Helenius and Stellan Hakansson and Junmin Yang and Amish Jain and Shah, {Prakesh S.} and Adele Harrison and Anne Synnes and Joseph Ting and Zenon Cieslak and Rebecca Sherlock and Wendy Yee and Khalid Aziz and Jennifer Toye and Carlos Fajardo and Zarin Kalapesi and Koravangattu Sankaran and Sibasis Daspal and Mary Seshia and Ruben Alvaro and Amit Mukerji and {Da Silva}, Orlando and Chuks Nwaesei and Lee, {Kyong Soon} and Michael Dunn and Brigitte Lemyre and Kimberly Dow and Ermelinda Pelausa and Keith Barrington and Christine Drolet and Bruno Piedboeuf and Martine Claveau and Marc Beltempo and Valerie Bertelle and Edith Masse and Roderick Canning and Hala Makary and Cecil Ojah and Luis Monterrosa and Akhil Deshpandey and Jehier Afifi and Andrzej Kajetanowicz and Sture Andersson and Outi Tammela and Ulla Sankilampi and Timo Saarela and Eli Heymann and Shmuel Zangen and Tatyana Smolkin and Francis Mimouni and David Bader and Avi Rothschild and Zipora Strauss and Clari Felszer and Hussam Omari and Tov-Friedman, {Smadar Even} and Benjamin Bar-Oz and Michael Feldman and Nizar Saad and Orna Flidel-Rimon and Meir Weisbrod and Daniel Lubin and Ita Litmanovitz and Amir Kugelman and Eric Shinwell and Gil Klinger and Yousif Nijim and Alona Bin-Nun and Agneta Golan and Dror Mandel and Vered Fleisher-Sheffer and David Kohelet and Lev Bakhrakh and Satoshi Hattori and Masaru Shirai and Toru Ishioka and Toshihiko Mori and Takasuke Amizuka and Toru Huchimukai and Hiroshi Yoshida and Ayako Sasaki and Junichi Shimizu and Toshihiko Nakamura and Mami Maruyama and Hiroshi Matsumoto and Shinichi Hosokawa and Atsuko Taki and Machiko Nakagawa and Kyone Ko and Azusa Uozumi and Setsuko Nakata and Akira Shimazaki and Tatsuya Yoda and Osamu Numata and Hiroaki Imamura and Azusa Kobayashi and Shuko Tokuriki and Yasushi Uchida and Takahiro Arai and Mitsuhiro Ito and Kuniko Ieda and Toshiyuki Ono and Masashi Hayashi and Kanemasa Maki and Yamakawa, {Mie Toru} and Masahiko Kawai and Noriko Fujii and Kozue Shiomi and Koji Nozaki and Hiroshi Wada and Taho Kim and Yasuyuki Tokunaga and Akihiro Takatera and Toshio Oshima and Hiroshi Sumida and Yae Michinomae and Yoshio Kusumoto and Seiji Yoshimoto and Takeshi Morisawa and Tamaki Ohashi and Yukihiro Takahashi and Moriharu Sugimoto and Noriaki Ono and Shinichiro Miyagawa and Takahiko Saijo and Takashi Yamagami and Kosuke Koyano and Shoko Kobayashi and Takeshi Kanda and Yoshihiro Sakemi and Mikio Aoki and Koichi Iida and Mitsushi Goshi and Yuko Maruyama and Jiri Kofron and Brodd, {Katarina Strand} and Andreas Odlind and Lars Alberg and Sofia Arwehed and Ola Hafstr{\"o}m and Anna Kasemo and Karin Nederman and Lars {\AA}hman and Fredrik Ingemarsson and Henrik Petersson and Pernilla Thurn and Eva Albinsson and Bo Selander and Thomas Abrahamsson and Ingela Heimdahl and Kristbjorg Sveinsdottir and Erik Wejryd and Anna Hedlund and S{\"o}derberg, {Maria Katarina} and Lars Nav{\'e}r and Thomas Brune and Jens B{\"a}ckstr{\"o}m and Johan Robinson and Aijaz Farooqi and Erik Normann and Magnus Fredriksson and Anders Palm and Urban Rosenqvist and Bengt Walde and Cecilia Hagman and Andreas Ohlin and Rein Florell and L{\"o}fvenberg, {Agneta Smedsaas} and Philipp Meyer and Rachel Kusche and Sven Schulzke and Mathias Nelle and Bendicht Wagner and Thomas Riedel and Gr{\'e}goire Kaczala and Pfister, {Riccardo E.} and Tolsa, {Jean Fran{\c c}ois} and Matthias Roth and Martin Stocker and Bernhard Laubscher and Andreas Malzacher and Micallef, {John P.} and Lukas Hegi and Romaine Arlettaz and Vera Bernet",

note = "Funding Information: Funding and Conflicts of Interest Disclosure: Funding for iNeo was provided by a Canadian Institutes of Health Research Chair in Reproductive and Child Health Services and Policy Research (APR-126340 [to P.S.]). The Canadian Neonatal Network is supported by a team grant from the Canadian Institutes of Health Research (CTP 87518), the Ontario Ministry of Health and Long-Term Care , and the participating centers. The Finnish Medical Birth Register is governmentally funded and kept by the National Institute for Health and Welfare (THL). The Israel Neonatal Network very low birth weight infant database is partly funded by the Israel Center for Disease Control and the Ministry of Health . The Neonatal Research Network of Japan is partly funded by a Health Labour Sciences Research Grant from the Ministry of Health, Labour and Welfare of Japan. The Swedish Neonatal Quality Register is funded by the Swedish Government ( Ministry of Health and Social Affairs, Sweden ), the body of regional health care providers (County Councils), and the participating units. The Swiss Neonatal Network is partly funded by participating units in the form of membership fees. The funders played no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the writing, review, or approval of the manuscript; or the decision to submit the manuscript for publication. The authors declare no conflicts of interest. Funding Information: Funding and Conflicts of Interest Disclosure: Funding for iNeo was provided by a Canadian Institutes of Health Research Chair in Reproductive and Child Health Services and Policy Research (APR-126340 [to P.S.]). The Canadian Neonatal Network is supported by a team grant from the Canadian Institutes of Health Research (CTP 87518), the Ontario Ministry of Health and Long-Term Care, and the participating centers. The Finnish Medical Birth Register is governmentally funded and kept by the National Institute for Health and Welfare (THL). The Israel Neonatal Network very low birth weight infant database is partly funded by the Israel Center for Disease Control and the Ministry of Health. The Neonatal Research Network of Japan is partly funded by a Health Labour Sciences Research Grant from the Ministry of Health, Labour and Welfare of Japan. The Swedish Neonatal Quality Register is funded by the Swedish Government (Ministry of Health and Social Affairs, Sweden), the body of regional health care providers (County Councils), and the participating units. The Swiss Neonatal Network is partly funded by participating units in the form of membership fees. The funders played no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the writing, review, or approval of the manuscript; or the decision to submit the manuscript for publication. The authors declare no conflicts of interest. Funding and conflict of interest statements available in the Appendix (www.jpeds.com). Publisher Copyright: {\textcopyright} 2020 Elsevier Inc.",

year = "2020",

month = may,

doi = "10.1016/j.jpeds.2020.01.069",

language = "English",

volume = "220",

pages = "34--39.e5",

journal = "Journal of Pediatrics",

issn = "0022-3476",

publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Neonatal Intensive Care Unit-Level Patent Ductus Arteriosus Treatment Rates and Outcomes in Infants Born Extremely Preterm

AU - Isayama, Tetsuya

AU - Kusuda, Satoshi

AU - Reichman, Brian

AU - Lee, Shoo K.

AU - Lehtonen, Liisa

AU - Norman, Mikael

AU - Adams, Mark

AU - Bassler, Dirk

AU - Helenius, Kjell

AU - Hakansson, Stellan

AU - Yang, Junmin

AU - Jain, Amish

AU - Shah, Prakesh S.

AU - Harrison, Adele

AU - Synnes, Anne

AU - Ting, Joseph

AU - Cieslak, Zenon

AU - Sherlock, Rebecca

AU - Yee, Wendy

AU - Aziz, Khalid

AU - Toye, Jennifer

AU - Fajardo, Carlos

AU - Kalapesi, Zarin

AU - Sankaran, Koravangattu

AU - Daspal, Sibasis

AU - Seshia, Mary

AU - Alvaro, Ruben

AU - Mukerji, Amit

AU - Da Silva, Orlando

AU - Nwaesei, Chuks

AU - Lee, Kyong Soon

AU - Dunn, Michael

AU - Lemyre, Brigitte

AU - Dow, Kimberly

AU - Pelausa, Ermelinda

AU - Barrington, Keith

AU - Drolet, Christine

AU - Piedboeuf, Bruno

AU - Claveau, Martine

AU - Beltempo, Marc

AU - Bertelle, Valerie

AU - Masse, Edith

AU - Canning, Roderick

AU - Makary, Hala

AU - Ojah, Cecil

AU - Monterrosa, Luis

AU - Deshpandey, Akhil

AU - Afifi, Jehier

AU - Kajetanowicz, Andrzej

AU - Andersson, Sture

AU - Tammela, Outi

AU - Sankilampi, Ulla

AU - Saarela, Timo

AU - Heymann, Eli

AU - Zangen, Shmuel

AU - Smolkin, Tatyana

AU - Mimouni, Francis

AU - Bader, David

AU - Rothschild, Avi

AU - Strauss, Zipora

AU - Felszer, Clari

AU - Omari, Hussam

AU - Tov-Friedman, Smadar Even

AU - Bar-Oz, Benjamin

AU - Feldman, Michael

AU - Saad, Nizar

AU - Flidel-Rimon, Orna

AU - Weisbrod, Meir

AU - Lubin, Daniel

AU - Litmanovitz, Ita

AU - Kugelman, Amir

AU - Shinwell, Eric

AU - Klinger, Gil

AU - Nijim, Yousif

AU - Bin-Nun, Alona

AU - Golan, Agneta

AU - Mandel, Dror

AU - Fleisher-Sheffer, Vered

AU - Kohelet, David

AU - Bakhrakh, Lev

AU - Hattori, Satoshi

AU - Shirai, Masaru

AU - Ishioka, Toru

AU - Mori, Toshihiko

AU - Amizuka, Takasuke

AU - Huchimukai, Toru

AU - Yoshida, Hiroshi

AU - Sasaki, Ayako

AU - Shimizu, Junichi

AU - Nakamura, Toshihiko

AU - Maruyama, Mami

AU - Matsumoto, Hiroshi

AU - Hosokawa, Shinichi

AU - Taki, Atsuko

AU - Nakagawa, Machiko

AU - Ko, Kyone

AU - Uozumi, Azusa

AU - Nakata, Setsuko

AU - Shimazaki, Akira

AU - Yoda, Tatsuya

AU - Numata, Osamu

AU - Imamura, Hiroaki

AU - Kobayashi, Azusa

AU - Tokuriki, Shuko

AU - Uchida, Yasushi

AU - Arai, Takahiro

AU - Ito, Mitsuhiro

AU - Ieda, Kuniko

AU - Ono, Toshiyuki

AU - Hayashi, Masashi

AU - Maki, Kanemasa

AU - Yamakawa, Mie Toru

AU - Kawai, Masahiko

AU - Fujii, Noriko

AU - Shiomi, Kozue

AU - Nozaki, Koji

AU - Wada, Hiroshi

AU - Kim, Taho

AU - Tokunaga, Yasuyuki

AU - Takatera, Akihiro

AU - Oshima, Toshio

AU - Sumida, Hiroshi

AU - Michinomae, Yae

AU - Kusumoto, Yoshio

AU - Yoshimoto, Seiji

AU - Morisawa, Takeshi

AU - Ohashi, Tamaki

AU - Takahashi, Yukihiro

AU - Sugimoto, Moriharu

AU - Ono, Noriaki

AU - Miyagawa, Shinichiro

AU - Saijo, Takahiko

AU - Yamagami, Takashi

AU - Koyano, Kosuke

AU - Kobayashi, Shoko

AU - Kanda, Takeshi

AU - Sakemi, Yoshihiro

AU - Aoki, Mikio

AU - Iida, Koichi

AU - Goshi, Mitsushi

AU - Maruyama, Yuko

AU - Kofron, Jiri

AU - Brodd, Katarina Strand

AU - Odlind, Andreas

AU - Alberg, Lars

AU - Arwehed, Sofia

AU - Hafström, Ola

AU - Kasemo, Anna

AU - Nederman, Karin

AU - Åhman, Lars

AU - Ingemarsson, Fredrik

AU - Petersson, Henrik

AU - Thurn, Pernilla

AU - Albinsson, Eva

AU - Selander, Bo

AU - Abrahamsson, Thomas

AU - Heimdahl, Ingela

AU - Sveinsdottir, Kristbjorg

AU - Wejryd, Erik

AU - Hedlund, Anna

AU - Söderberg, Maria Katarina

AU - Navér, Lars

AU - Brune, Thomas

AU - Bäckström, Jens

AU - Robinson, Johan

AU - Farooqi, Aijaz

AU - Normann, Erik

AU - Fredriksson, Magnus

AU - Palm, Anders

AU - Rosenqvist, Urban

AU - Walde, Bengt

AU - Hagman, Cecilia

AU - Ohlin, Andreas

AU - Florell, Rein

AU - Löfvenberg, Agneta Smedsaas

AU - Meyer, Philipp

AU - Kusche, Rachel

AU - Schulzke, Sven

AU - Nelle, Mathias

AU - Wagner, Bendicht

AU - Riedel, Thomas

AU - Kaczala, Grégoire

AU - Pfister, Riccardo E.

AU - Tolsa, Jean François

AU - Roth, Matthias

AU - Stocker, Martin

AU - Laubscher, Bernhard

AU - Malzacher, Andreas

AU - Micallef, John P.

AU - Hegi, Lukas

AU - Arlettaz, Romaine

AU - Bernet, Vera

N1 - Funding Information: Funding and Conflicts of Interest Disclosure: Funding for iNeo was provided by a Canadian Institutes of Health Research Chair in Reproductive and Child Health Services and Policy Research (APR-126340 [to P.S.]). The Canadian Neonatal Network is supported by a team grant from the Canadian Institutes of Health Research (CTP 87518), the Ontario Ministry of Health and Long-Term Care , and the participating centers. The Finnish Medical Birth Register is governmentally funded and kept by the National Institute for Health and Welfare (THL). The Israel Neonatal Network very low birth weight infant database is partly funded by the Israel Center for Disease Control and the Ministry of Health . The Neonatal Research Network of Japan is partly funded by a Health Labour Sciences Research Grant from the Ministry of Health, Labour and Welfare of Japan. The Swedish Neonatal Quality Register is funded by the Swedish Government ( Ministry of Health and Social Affairs, Sweden ), the body of regional health care providers (County Councils), and the participating units. The Swiss Neonatal Network is partly funded by participating units in the form of membership fees. The funders played no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the writing, review, or approval of the manuscript; or the decision to submit the manuscript for publication. The authors declare no conflicts of interest. Funding Information: Funding and Conflicts of Interest Disclosure: Funding for iNeo was provided by a Canadian Institutes of Health Research Chair in Reproductive and Child Health Services and Policy Research (APR-126340 [to P.S.]). The Canadian Neonatal Network is supported by a team grant from the Canadian Institutes of Health Research (CTP 87518), the Ontario Ministry of Health and Long-Term Care, and the participating centers. The Finnish Medical Birth Register is governmentally funded and kept by the National Institute for Health and Welfare (THL). The Israel Neonatal Network very low birth weight infant database is partly funded by the Israel Center for Disease Control and the Ministry of Health. The Neonatal Research Network of Japan is partly funded by a Health Labour Sciences Research Grant from the Ministry of Health, Labour and Welfare of Japan. The Swedish Neonatal Quality Register is funded by the Swedish Government (Ministry of Health and Social Affairs, Sweden), the body of regional health care providers (County Councils), and the participating units. The Swiss Neonatal Network is partly funded by participating units in the form of membership fees. The funders played no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the writing, review, or approval of the manuscript; or the decision to submit the manuscript for publication. The authors declare no conflicts of interest. Funding and conflict of interest statements available in the Appendix (www.jpeds.com). Publisher Copyright: © 2020 Elsevier Inc.

PY - 2020/5

Y1 - 2020/5

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85081399730&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85081399730&partnerID=8YFLogxK

U2 - 10.1016/j.jpeds.2020.01.069

DO - 10.1016/j.jpeds.2020.01.069

M3 - Article

C2 - 32145968

AN - SCOPUS:85081399730

SN - 0022-3476

VL - 220

SP - 34-39.e5

JO - Journal of Pediatrics

JF - Journal of Pediatrics

ER -

Neonatal Intensive Care Unit-Level Patent Ductus Arteriosus Treatment Rates and Outcomes in Infants Born Extremely Preterm

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