Decrease in the frequency of treatment for patent ductus arteriosus after implementation of consensus guidelines: a 15-year experience

Lara Pavageau, Luc P Brion, Charles R Rosenfeld, L. Steven Brown, Claudio Ramaciotti, P. Jeannette Burchfield, Mambarambath A Jaleel

Research output: Contribution to journalArticle

Abstract

Background: Patent ductus arteriosus (PDA) management varies widely among neonatologists. Local problem: Lack of institution-specific evidence-based guidelines for therapeutic closure of PDA. Methods: Quality improvement project among infants <30 weeks gestational age (GA) designed to determine whether the odds of therapy for closing the PDA, adjusted for GA, decreased after implementing evidence-based guidelines. Intervention: Implementation of guidelines with conservative approach to PDA management. Results: The frequency of PDA treatment decreased from 446/1125 (40%) in Epoch 1 to 96/482 (20%) in Epoch 2. PDA treatment was more frequent in neonates 23–26 weeks GA than those of 27–29 weeks GA (43% vs. 28%, respectively). Among 542 infants receiving indomethacin for PDA, 25% had subsequent ligation; the odds of ligation after indomethacin were lower in neonates 27–29 weeks GA and decreased during Epoch 2. Conclusions: The frequency of medical and surgical treatment for therapeutic closure of PDA decreased after implementing evidence-based treatment guidelines.

Original languageEnglish (US)
JournalJournal of Perinatology
DOIs
StatePublished - Jan 1 2019

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Patent Ductus Arteriosus
Guidelines
Gestational Age
Therapeutics
Indomethacin
Ligation
Newborn Infant
Quality Improvement

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

@article{cfbbeb46e487445aae682e16034af9a3,
title = "Decrease in the frequency of treatment for patent ductus arteriosus after implementation of consensus guidelines: a 15-year experience",
abstract = "Background: Patent ductus arteriosus (PDA) management varies widely among neonatologists. Local problem: Lack of institution-specific evidence-based guidelines for therapeutic closure of PDA. Methods: Quality improvement project among infants <30 weeks gestational age (GA) designed to determine whether the odds of therapy for closing the PDA, adjusted for GA, decreased after implementing evidence-based guidelines. Intervention: Implementation of guidelines with conservative approach to PDA management. Results: The frequency of PDA treatment decreased from 446/1125 (40{\%}) in Epoch 1 to 96/482 (20{\%}) in Epoch 2. PDA treatment was more frequent in neonates 23–26 weeks GA than those of 27–29 weeks GA (43{\%} vs. 28{\%}, respectively). Among 542 infants receiving indomethacin for PDA, 25{\%} had subsequent ligation; the odds of ligation after indomethacin were lower in neonates 27–29 weeks GA and decreased during Epoch 2. Conclusions: The frequency of medical and surgical treatment for therapeutic closure of PDA decreased after implementing evidence-based treatment guidelines.",
author = "Lara Pavageau and Brion, {Luc P} and Rosenfeld, {Charles R} and Brown, {L. Steven} and Claudio Ramaciotti and Burchfield, {P. Jeannette} and Jaleel, {Mambarambath A}",
year = "2019",
month = "1",
day = "1",
doi = "10.1038/s41372-019-0432-8",
language = "English (US)",
journal = "Journal of Perinatology",
issn = "0743-8346",
publisher = "Nature Publishing Group",

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T2 - a 15-year experience

AU - Pavageau, Lara

AU - Brion, Luc P

AU - Rosenfeld, Charles R

AU - Brown, L. Steven

AU - Ramaciotti, Claudio

AU - Burchfield, P. Jeannette

AU - Jaleel, Mambarambath A

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Patent ductus arteriosus (PDA) management varies widely among neonatologists. Local problem: Lack of institution-specific evidence-based guidelines for therapeutic closure of PDA. Methods: Quality improvement project among infants <30 weeks gestational age (GA) designed to determine whether the odds of therapy for closing the PDA, adjusted for GA, decreased after implementing evidence-based guidelines. Intervention: Implementation of guidelines with conservative approach to PDA management. Results: The frequency of PDA treatment decreased from 446/1125 (40%) in Epoch 1 to 96/482 (20%) in Epoch 2. PDA treatment was more frequent in neonates 23–26 weeks GA than those of 27–29 weeks GA (43% vs. 28%, respectively). Among 542 infants receiving indomethacin for PDA, 25% had subsequent ligation; the odds of ligation after indomethacin were lower in neonates 27–29 weeks GA and decreased during Epoch 2. Conclusions: The frequency of medical and surgical treatment for therapeutic closure of PDA decreased after implementing evidence-based treatment guidelines.

AB - Background: Patent ductus arteriosus (PDA) management varies widely among neonatologists. Local problem: Lack of institution-specific evidence-based guidelines for therapeutic closure of PDA. Methods: Quality improvement project among infants <30 weeks gestational age (GA) designed to determine whether the odds of therapy for closing the PDA, adjusted for GA, decreased after implementing evidence-based guidelines. Intervention: Implementation of guidelines with conservative approach to PDA management. Results: The frequency of PDA treatment decreased from 446/1125 (40%) in Epoch 1 to 96/482 (20%) in Epoch 2. PDA treatment was more frequent in neonates 23–26 weeks GA than those of 27–29 weeks GA (43% vs. 28%, respectively). Among 542 infants receiving indomethacin for PDA, 25% had subsequent ligation; the odds of ligation after indomethacin were lower in neonates 27–29 weeks GA and decreased during Epoch 2. Conclusions: The frequency of medical and surgical treatment for therapeutic closure of PDA decreased after implementing evidence-based treatment guidelines.

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