Outcomes of Patent Ductus Arteriosus Closure by Availability of Cardiac Surgeons for Infants Born Preterm.

Abstract

To evaluate the treatment strategies for closure of patent ductus arteriosus (PDA) and clinical outcomes among very preterm infants based upon the availability of cardiac surgeons in neonatal intensive care units (NICUs). This study retrospectively assessed infants born at 23-29 weeks of gestation who participated in a prior prospective cohort study in Japan. The primary outcome was PDA surgery. The secondary outcomes included mortality and various morbidities, such as intraventricular hemorrhage and chronic lung disease (CLD). Outcomes were compared between with-surgeon and no-surgeon NICUs using generalized linear mixed effect models, adjusted for gestational age, antenatal corticosteroid, small-for-gestational age, and unit patient volume. This study included 613 infants from 27 NICUs, including 245 from 9 no-surgeon NICUs and 368 from 18 with-surgeon NICUs. Infants received significantly more prophylactic indomethacin in the no-surgeon NICUs than those in the with-surgeon NICUs. The frequency of PDA surgery showed no significant difference between the groups (9.0% vs 12%, adjusted odds ratio [aOR]: 0.56 [95% confidence interval: 0.21-1.51]). CLD was significantly more frequent in no-surgeon NICUs than in with-surgeon NICUs (55% vs 40%, aOR: 3.24 [95% CI 1.45-7.29]). The frequency of PDA surgery did not differ significantly according to the availability of surgeons. The incidence of CLD was higher in no-surgeon NICUs; however, the risk of unmeasured confounding cannot be excluded due to the observational study design.