Screening for Patent Ductus Arteriosus in Preterm Infants | Journal Scan

Study Questions:

What is the association between early screening echocardiography for patent ductus arteriosus (PDA) and in-hospital mortality?

Methods:

This study made use of data from the EPIPAGE 2 study, a national, prospective, population-based cohort study conducted in France in 2011. The study enrolled all preterm infants born at less than 29 weeks gestation. Two main analyses were performed to adjust for potential selection bias. The first used propensity-score matching and the second used neonatal preference for early screening as an instrumental variable.

Results:

Of a total of 1,513 preterm infants, 847 were screened for PDA and 666 were not. Paired analysis of 605 infants from each group was performed. Infants exposed to screening were treated for PDA more frequently than nonexposed infants (55.1% vs. 43.1%; odds ratio [OR], 1.62; 95% confidence interval [CI], 1.31-2.00). Exposed infants had a lower hospital death rate (14.2% vs. 18.5%; OR, 0.73; 95% CI, 0.54-0.98), and a lower rate of pulmonary hemorrhage (5.6% vs. 8.9%; OR, 0.60; 95% CI, 0.38-0.95). No differences in rates of necrotizing enterocolitis, severe bronchopulmonary dysplasia, or severe cerebral lesions were observed. The number of infants needed to be screened to prevent one death was 23.

Conclusions:

The authors concluded that screening echocardiography before day 3 of life was associated with lower in-hospital mortality and likelihood of pulmonary hemorrhage. The results of instrumental variable analysis leave some ambiguity in the interpretation, and long-term evaluation is required.

Perspective:

The role for screening for and empiric treatment of PDA in preterm infants remains controversial. Randomized trials of both medical and surgical closure have failed to consistently demonstrate survival benefit. This study made use of a national prospective study to assess the impact of early screening, with the assumption that early screening would be associated with earlier and more frequent treatment. Multiple analyses were performed to correct for possible confounders. The primary limitation of the study is the possibility of uncontrolled confounders. Additionally, the study was not designed to identify possible consequences or complications of early treatment.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Congenital Heart Disease, CHD & Pediatrics and Quality Improvement

Keywords: Bronchopulmonary Dysplasia, Cohort Studies, Ductus Arteriosus, Patent, Enterocolitis, Necrotizing, Heart Defects, Congenital, Hemorrhage, Hospital Mortality, Infant, Extremely Premature, Infant, Premature, Infant, Premature, Diseases, Propensity Score, Prospective Studies, Selection Bias


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