Variation and comparative effectiveness of patent ductus arteriosus pharmacotherapy in extremely low birth weight infants

Article type: Research Article

Authors: ElHassan, N.O. | Bird, T.M. | King, A.J. | Ambadwar, P.B. | Jaquiss, R.D.B. | Kaiser, J.R. | Robbins, J.M.

Affiliations: University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA | Department of Health Policy & Management, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA | Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA | Cancer Center Statistics, Mayo Clinic, Rochester, MN, USA | Section of Surgery and Pediatrics, Duke Children's Hospital, Durham, NC, USA | Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA | Department of Pediatrics and Psychiatry, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA

Note: [] Corresponding author: Dr. Nahed O. ElHassan, Department of Pediatrics/Neonatology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, 1 Children's Way, Slot 512-5, Little Rock AR 72202, USA. Tel.: +1 501 364 1028; Fax: +1 501 364 4264; E-mail: ElhassanNahed@uams.edu

Abstract: BACKGROUND: Patent ductus arteriosus (PDA) occurs in 70% of extremely low birth weight (ELBW, birth weight <1000 g) infants. Approximately 34% of ELBW infants with a PDA have spontaneous closure. Failure of the ductus arteriosus to close has been associated with multiple morbidities. OBJECTIVE: To examine variability over time and across hospitals in early therapeutic (2–7 day) use of indomethacin (INDO) vs ibuprofen (IBU) for PDA treatment in outborn ELBW infants and examine the outcomes and side effects of both pharmacological agents in this population. METHODS: Data were extracted from the Pediatric Health Information System. ELBW infants born between January 1, 2007 and December 31, 2010 and admitted on day of life 0 were eligible for inclusion. 732 infants had a PDA diagnosis and met inclusion criteria. We explored the variability in PDA pharmacotherapy over time and across hospitals. We compared outcomes of both agents for in-hospital mortality, need for surgical ligation, intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, periventricular leukomalacia, renal failure, and persistent pulmonary hypertension. Statistical methods included chi square and multivariable regression analysis. Instrumental variable analysis was used to control for selection bias and omitted variables. RESULTS: There was large variability in PDA pharmacotherapy over time and across hospitals. INDO use declined as IBU use grew from 12.8 to 38.9%. There was no difference in hospital or NICU characteristics between high and low IBU using NICUs. Renal failure was more common in infants receiving INDO compared to IBU. CONCLUSION: We noted large variability in PDA pharmacotherapy. Renal failure was more common with INDO use. Until further studies to compare the long-term effects of both drugs, our data support IBU as the preferred medication for PDA pharmacotherapy in ELBW infants.

Keywords: Patent ductus arteriosus, indomethacin, ibuprofen, extremely low birth weight infants

DOI: 10.3233/NPM-14814015

Journal: Journal of Neonatal-Perinatal Medicine, vol. 7, no. 3, pp. 229-235, 2014