198 - International variations in the management of patent ductus arteriosus in 12 countries or regions

Publication Number: 198.5266

Tetsuya Isayama, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan; Satoshi Kusuda, Neonatal Research Network of Japan, Taito, Tokyo, Japan; Mark Adams, University Hospital Zurich, Zurich, Zurich, Switzerland; Neha Goswami, Mount Sinai Hospital, Toronto, ON, Canada; Gil Klinger, Schneider Children's Medical Center of Israel and Tel Aviv University, Ramat Hasharon, HaMerkaz, Israel; Laura San Feliciano, Hospital Universitario de Salamanca, Salamanca, Castilla y Leon, Spain; Marc Beltempo, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada; Witold Błaż, Clinical Provincial Hospital No 2 University of Rzeszow, Poland, Rzeszów, Podkarpackie, Poland; Kei Lui, University of New South Wales, Sydney, New South Wales, Australia; Kjell Helenius, University of Turku, Turku, Varsinais-Suomi, Finland; Malcolm Battin, Auckland City Hospitial, Auckland, Auckland, New Zealand; Dirk Bassler, University Hospital of Zurich, Zurich, Zurich, Switzerland; Maximo Vento, Instituto de Investigación Sanitaria La Fe, VALENCIA, Comunidad Valenciana, Spain; Brian Reichman, Sheba Medical Center, Ramat Gan, HaMerkaz, Israel; Mikael Norman, Karolinska Institutet, Stockholm, Stockholms Lan, Sweden; Valerie Biran, Robert Debre Children's Hospital, Assistance Publique Hôpitaux de Paris,Université Paris-Cité, INSERM U1141, France, Paris, Ile-de-France, France; Liisa Lehtonen, University of Turku, Turku, Varsinais-Suomi, Finland; Elettra Berti, University of Florence, Florence, Toscana, Italy; Lilian dos Santos Rodrigues Sadeck, Universidade de Sao Paulo, São Paulo, Sao Paulo, Brazil; Prakesh S. Shah, Mount Sinai Hospital, Toronto, ON, Canada

Background: Controversies on how to manage patent ductus arteriosus (PDA) in very preterm infants have continued even after many clinical trials have been completed and published.

Objective: To survey the variations in the management of PDA in preterm neonates of < 29 weeks’ gestation among neonatal units of 12 population-based national or regional neonatal networks participating in the International Network for Evaluating Outcomes in Neonates (iNeo).

Design/Methods: Online pre-piloted questionnaires were sent to the directors or representatives of 608 NICU’s participating in Australia/New-Zealand (ANZNN n= 30), Brazil (BZ=20), Canada (CNN, n=32), Finland (FinMBR, n=5), France (FR, n=70), Israel (INN, n=26), Japan (NRNJ, n=292), Poland (PL, n=56), Spain (SEN1500, n=55), Sweden (SNQ n=9), Switzerland (SwissNeoNet n=9), and Tuscany, Italy (TuscanNN n=4). The responses were based on practices in 2023. Two reminders were sent.

Results: Overall, 383 units (63%) responded. The survey response varied from 37-100% among participating networks. The availability of persons who can perform echocardiography for assessing cardiac function and PDA widely varied among networks (20-100% of NICUs; Figure 1a). Echocardiography was routinely performed in 29-100% of NICUs in each network to assess cardiac function and PDA regardless of clinical signs in preterm infants (Figure 1b). Hemodynamically significant PDA were treated based the finding of echocardiography without clinical signs in 0-64% of NICUs (Figure 2a). Although Ibuprofen or Indomethacin were the first line pharmacological treatment of PDA in many countries (31-88% of NICUs), more than 30 % of NICUs in ANZNN and INN used Acetaminophen as the first line (35% and 48% of NICUs, respectively; Figure 2b). As a surgical treatment, PDA ligation via open thoracotomy was the primary method in many countries (34-100% of NICUs); however, transcatheter closure of PDA was the primary method in 50% of NICUs in France and small proportion (10-23%) of NICUs in several other countries (Figure 2c).

Conclusion(s): There were marked variations in PDA management of very preterm infants between countries. There was a trend toward an increasing number of facilities using acetaminophen as the first line pharmacological treatment and those offering transcatheter PDA closure. Further collaboration and exploration is needed to better understand the association of these variations in practice with variations in mortality and morbidities across different countries and units.

Figure 1: Availability and routine use of echocardiography to assess cardiac function and PDA
The data were the proportions of units that selected each option in the survey. The number of units that answered to the survey were the following: ANZNN (n=21), BNN (n=20), CNN (n=30), FinMBR (n=5), France (n=68), INN (n=23), NRNJ (n=108), Poland (n=55), SEN1500 (n=30), SNN (n=9), SNQ (n=9), and TuscanNN (n=4). Abbreviations: ANZNN-Australian and New Zealand Neonatal Network, BNN-Brazilian Neonatal Network, CNN-Canadian Neonatal Network, FinMBR-Finnish Medical Birth Register, INN-Israel Neonatal Network, n.a.-not available, NRNJ-Neonatal Research Network Japan, SEN1500-Spanish Neonatal Network, SNQ-Swedish Neonatal Quality Register, SNN-Swiss Neonatal Network, TuscanNN-Tuscany Neonatal Network.

Figure 2: Pharmacological and surgical treatment of PDA
The data were the proportions of units that selected each option in the survey.