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Title: Patent ductus arteriosus treatment in very preterm infants: a European population-based cohort study (EPICE) on variation and outcomes
Authors: Edstedt Bonamy, A-K.
Gudmundsdottir, A.
Maier, R. F.
Toome, L.
Zeitlin, J.
Bonet, M.
Fenton, A.
Hasselager, A. B.
Van Heijst, A.
Gortner, L.
Milligan, D.
Van Reempts, P.
Boyle, Elaine M.
Norman, M.
First Published: 2017
Publisher: Karger Publishers
Citation: Neonatology, 2017,111:367-375
Abstract: Background: Spontaneous closure of patent ductus arteriosus (PDA) occurs frequently in very preterm infants and despite the lack of evidence for treatment benefits, treatment for PDA is common in neonatal medicine. Objectives: To study regional variation in PDA treatment in very preterm infants (≤31 weeks gestational weeks), its relation to differences in perinatal characteristics and associations with bronchopulmonary dysplasia (BPD) and survival without major neonatal morbidity. Methods: Population-based cohort study in 19 regions in 11 European countries 2011-2012. 6,896 infants with data on PDA treatment were included. Differences in infant characteristics were studied across regions using a propensity score derived from perinatal risk factors for PDA treatment. Primary outcomes were a composite of BPD or death before 36 weeks postmenstrual age, or survival without major neonatal morbidity. Results: The proportion of PDA treatment varied from 10 to 39% between regions (p<0.001). and this difference could not be explained by differences in perinatal characteristics . Regions were categorized according to low (<15%, n=6), medium (15-25%, n=9) or high (>25%, n=4) proportion of PDA treatment. Infants treated for PDA, compared to not treated, were at higher risk of BPD or death in all regions, with an overall propensity score adjusted risk ratio of 1.33 (95% confidence interval 1.18-1.51). Survival without major neonatal morbidity was not related to PDA treatment. Conclusions: PDA treatment varies largely across Europe without associated variations in perinatal characteristics or neonatal outcomes. This finding calls for more uniform guidance for PDA diagnosis and treatment in very preterm infants.
DOI Link: 10.1159/000454798
ISSN: 1661-7800
eISSN: 1661-7819
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Creative Commons “Attribution Non-Commercial No Derivatives” licence CC BY-NC-ND, further details of which can be found via the following link: Archived with reference to SHERPA/RoMEO and publisher website.
Description: Embargoed until publication
Appears in Collections:Published Articles, Dept. of Health Sciences

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R2_PDA_EPICE_final_Neonatology_unmarked_161124.docxPost-review (final submitted author manuscript)72.53 kBUnknownView/Open
Table 1_neo_R2_final.docxPost-review (final submitted author manuscript)19.71 kBUnknownView/Open
Fig3_R2.jpgPost-review (final submitted author manuscript)230.47 kBJPEGThumbnail
Flödes_ppt_R2.pdfPost-review (final submitted author manuscript)103.16 kBAdobe PDFView/Open
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Online Figure 2_final.pdfPost-review (final submitted author manuscript)135.3 kBAdobe PDFView/Open
Online figure1_final.pdfPost-review (final submitted author manuscript)184.7 kBAdobe PDFView/Open
Online Table 1_final.docxPost-review (final submitted author manuscript)16.39 kBUnknownView/Open
Table 2_neo_R2_final.docxPost-review (final submitted author manuscript)16.05 kBUnknownView/Open
Table 3_neo_R2.docxPost-review (final submitted author manuscript)19.43 kBUnknownView/Open
Online Table 2_final.docxPost-review (final submitted author manuscript)16.83 kBUnknownView/Open
Online Table 3_final.docxPost-review (final submitted author manuscript)19.05 kBUnknownView/Open
R2_PDA_EPICE_final_Neonatology_unmarked_161124.pdfPost-review (final submitted author manuscript)251.7 kBAdobe PDFView/Open

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