Original ArticleTreatment of Patent Ductus Arteriosus and Neonatal Mortality/Morbidities: Adjustment for Treatment Selection Bias
Section snippets
Methods
These secondary analyses examined data from preterm infants born between 2004 and 2008 at GA ≤32 weeks and diagnosed with PDA from 22 neonatal intensive care units (NICUs) that contributed data to the Canadian Neonatal Network (CNN). All NICUs are regional tertiary level referral centers and the CNN database comprises >90% of admissions to level 3 NICUs in Canada. The NICUs ranged in size from 9-70 beds and included between 74 and 1122 admissions annually. Data were collected by trained
Results
A total of 14 418 infants born at ≤32 weeks GA were admitted to NICUs participating in the CNN during the study period, of whom 3673 (25%) were diagnosed with PDA. After exclusion of 35 infants with PDA who died within 72 hours after birth and 82 infants with congenital heart defects, we examined data from 3556 infants admitted to 22 sites. Significant differences between PDA treatment groups were detected for the following potential confounders: year of birth, CNN site, GA, inborn/outborn
Discussion
Although ligation of PDA is considered the definitive treatment option, the evidence regarding the impact of this procedure on mortality and/or severe neonatal morbidities is conflicting. A randomized controlled trial of prophylactic ligation13 showed decreased rates of NEC in infants with early compared with late ligation; an observational study19 reported decreased mortality for ligation compared with only indomethacin treatment; and in a study of preterm baboons, Loeliger et al34
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The Canadian Institutes of Health Research team in Maternal-Infant Care (MiCare) provided organizational support to the Canadian Neonatal Network. The Maternal-Infant Care Research Center is supported by the Ministry of Health and Long-Term Care, Ontario, Canada. The authors declare no conflicts of interest.
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List of members of the Canadian Neonatal Network is available at www.jpeds.com (Appendix).