Tetsuya Isayama1, Lucia Mirea1, Rintaro Mori2, Satoshi Kusuda3, Masanori Fujimura4, Shoo K Lee1, Prakesh S Shah1. 1. Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada. 2. Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan. 3. Department of Neonatology, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan. 4. Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
Abstract
OBJECTIVE: The aim of this study is to compare patent ductus arteriosus (PDA) management strategies and outcomes between the Neonatal Research Network of Japan (NRNJ) with proactive functional echocardiography and the Canadian Neonatal Network (CNN) with selective conventional echocardiography practice. STUDY DESIGN: Retrospective analyses examined very low-birth-weight infants admitted to the NRNJ or CNN in 2006 to 2008. Multivariable logistic regression analyses compared a composite outcome indicating a mortality or major morbidity (severe intraventricular hemorrhage, periventricular leukomalacia, severe retinopathy of prematurity, bronchopulmonary dysplasia, or necrotizing enterocolitis) between networks, according to PDA diagnosis and treatment, and tested the association between PDA treatment and the composite outcome within networks. RESULTS: PDA treatment (NRNJ:CNN) with conservative management (8%:16%), indomethacin only (77%:59%), ligation only (1%:13%), or indomethacin and ligation (14%:13%) varied significantly between networks. The composite outcome was lower in NRNJ versus CNN only among infants with PDA (odds ratio: 0.70; 95% confidence interval: 0.62-0.80). Surgical ligation was associated with higher composite outcome only in CNN (odds ratio: 1.79; 95% confidence interval: 1.40-2.28). CONCLUSION: Lower composite mortality/morbidity outcome in Japan versus Canada only among infants with PDA, and association of surgical ligation with higher mortality/morbidity only in Canada, suggest differential PDA management and ligation processes contribute to outcome variation. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
OBJECTIVE: The aim of this study is to compare patent ductus arteriosus (PDA) management strategies and outcomes between the Neonatal Research Network of Japan (NRNJ) with proactive functional echocardiography and the Canadian Neonatal Network (CNN) with selective conventional echocardiography practice. STUDY DESIGN: Retrospective analyses examined very low-birth-weight infants admitted to the NRNJ or CNN in 2006 to 2008. Multivariable logistic regression analyses compared a composite outcome indicating a mortality or major morbidity (severe intraventricular hemorrhage, periventricular leukomalacia, severe retinopathy of prematurity, bronchopulmonary dysplasia, or necrotizing enterocolitis) between networks, according to PDA diagnosis and treatment, and tested the association between PDA treatment and the composite outcome within networks. RESULTS: PDA treatment (NRNJ:CNN) with conservative management (8%:16%), indomethacin only (77%:59%), ligation only (1%:13%), or indomethacin and ligation (14%:13%) varied significantly between networks. The composite outcome was lower in NRNJ versus CNN only among infants with PDA (odds ratio: 0.70; 95% confidence interval: 0.62-0.80). Surgical ligation was associated with higher composite outcome only in CNN (odds ratio: 1.79; 95% confidence interval: 1.40-2.28). CONCLUSION: Lower composite mortality/morbidity outcome in Japan versus Canada only among infants with PDA, and association of surgical ligation with higher mortality/morbidity only in Canada, suggest differential PDA management and ligation processes contribute to outcome variation. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Authors: Prakesh S Shah; Kei Lui; Brian Reichman; Mikael Norman; Satoshi Kusuda; Liisa Lehtonen; Mark Adams; Maximo Vento; Brian A Darlow; Neena Modi; Franca Rusconi; Stellan Håkansson; Laura San Feliciano; Kjell K Helenius; Dirk Bassler; Shinya Hirano; Shoo K Lee Journal: Transl Pediatr Date: 2019-07
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