Feeding Practices and Patent Ductus Arteriosus Ligation Preferences—Are They Related?

ABSTRACT

We hypothesized that there is a significant relationship between a neonatologist's belief that feedings must be stopped in the presence of a patent ductus arteriosus (PDA) and his or her willingness to ligate a PDA. We administered the same survey questionnaire to two separate populations of neonatologists to assess their beliefs regarding PDA treatment practices. Although >90% of U.S. and non-U.S. neonatologists reported that they would ligate a PDA when infants with birth weights <900 g required mechanical ventilation (and indomethacin was contraindicated or had failed to close the PDA), U.S. neonatologists reported that they were significantly more likely to ligate a PDA when less respiratory support was required. U.S. neonatologists were also more likely to stop feedings when a PDA was present. The reported likelihood that a neonatologist would ligate a PDA in infants who did not require mechanical ventilation was significantly increased if the neonatologist believed that feedings had to be stopped because of the PDA. After controlling for the belief that “feedings must be stopped in the presence of a PDA,” the significant difference between U.S. and non-U.S. neonatologists, in their reported desire to ligate infants who did not require mechanical ventilation, was no longer present.

KEYWORDS

Patent ductus arteriosus - survey - indomethacin - ligation - international - feeding practices

REFERENCES

• 1 Fowlie P W, Davis P G. Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants.  Cochrane Database Syst Rev. 2002;  (3) CD000174
• 2 Ment L R, Oh W, Ehrenkranz R A et al.. Low-dose indomethacin and prevention of intraventricular hemorrhage: a multicenter randomized trial.  Pediatrics. 1994;  93 543-550
• 3 Schmidt B, Davis P, Moddemann D Trial of Indomethacin Prophylaxis in Preterms Investigators et al. Long-term effects of indomethacin prophylaxis in extremely-low-birth-weight infants.  N Engl J Med. 2001;  344 1966-1972
• 4 Bandstra E S, Montalvo B M, Goldberg R N et al.. Prophylactic indomethacin for prevention of intraventricular hemorrhage in premature infants.  Pediatrics. 1988;  82 533-542
• 5 Clyman R I, Chorne N. Patent ductus arteriosus: evidence for and against treatment.  J Pediatr. 2007;  150 216-219
• 6 Laughon M M, Simmons M A, Bose C L. Patency of the ductus arteriosus in the premature infant: is it pathologic? Should it be treated?.  Curr Opin Pediatr. 2004;  16 146-151
• 7 Bose C L, Laughon M. Treatment to prevent patency of the ductus arteriosus: beneficial or harmful?.  J Pediatr. 2006;  148 713-714
• 8 Kääpä P, Lanning P, Koivisto M. Early closure of patent ductus arteriosus with indomethacin in preterm infants with idiopathic respiratory distress syndrome.  Acta Paediatr Scand. 1983;  72 179-184
• 9 Cotton R B, Stahlman M T, Bender H W, Graham T P, Catterton W Z, Kovar I. Randomized trial of early closure of symptomatic patent ductus arteriosus in small preterm infants.  J Pediatr. 1978;  93 647-651
• 10 Bose C L, Laughon M M. Patent ductus arteriosus: lack of evidence for common treatments.  Arch Dis Child Fetal Neonatal Ed. 2007;  92 F498-F502
• 11 McCurnin D, Clyman R I. Effects of a patent ductus arteriosus on postprandial mesenteric perfusion in premature baboons.  Pediatrics. 2008;  122 e1262-e1267
• 12 Cassady G, Crouse D T, Kirklin J W et al.. A randomized, controlled trial of very early prophylactic ligation of the ductus arteriosus in babies who weighed 1000 g or less at birth.  N Engl J Med. 1989;  320 1511-1516
• 13 Dollberg S, Lusky A, Reichman B. Patent ductus arteriosus, indomethacin and necrotizing enterocolitis in very low birth weight infants: a population-based study.  J Pediatr Gastroenterol Nutr. 2005;  40 184-188
• 14 Sankaran K, Puckett B, Lee D S Canadian Neonatal Network et al. Variations in incidence of necrotizing enterocolitis in Canadian neonatal intensive care units.  J Pediatr Gastroenterol Nutr. 2004;  39 366-372
• 15 Clyman R I, Saha S, Jobe A, Oh W. Indomethacin prophylaxis for preterm infants: the impact of 2 multicentered randomized controlled trials on clinical practice.  J Pediatr. 2007;  150 46-50, e2
• 16 Chorne N, Leonard C, Piecuch R, Clyman R I. Patent ductus arteriosus and its treatment as risk factors for neonatal and neurodevelopmental morbidity.  Pediatrics. 2007;  119 1165-1174
• 17 Madan J C, Kendrick D, Hagadorn J I, Frantz III I D. National Institute of Child Health and Human Development Neonatal Research Network . Patent ductus arteriosus therapy: impact on neonatal and 18-month outcome.  Pediatrics. 2009;  123 674-681
• 18 Aranda J V, Clyman R, Cox B et al.. A randomized, double-blind, placebo-controlled trial on intravenous ibuprofen L-lysine for the early closure of nonsymptomatic patent ductus arteriosus within 72 hours of birth in extremely low-birth-weight infants.  Am J Perinatol. 2009;  26 235-245
• 19 Kobaly K, Schluchter M, Minich N et al.. Outcomes of extremely low birth weight (<1 kg) and extremely low gestational age (<28 weeks) infants with bronchopulmonary dysplasia: effects of practice changes in 2000 to 2003.  Pediatrics. 2008;  121 73-81
• 20 Lemons J A, Bauer C R, Oh W NICHD Neonatal Research Network et al. Very low birth weight outcomes of the National Institute of Child health and human development neonatal research network, January 1995 through December 1996.  Pediatrics. 2001;  107 E1
• 21 Kusuda S, Fujimura M, Sakuma I Neonatal Research Network, Japan et al. Morbidity and mortality of infants with very low birth weight in Japan: center variation.  Pediatrics. 2006;  118 e1130-e1138
• 22 Patel J, Roberts I, Azzopardi D, Hamilton P, Edwards A D. Randomized double-blind controlled trial comparing the effects of ibuprofen with indomethacin on cerebral hemodynamics in preterm infants with patent ductus arteriosus.  , [see comments] Pediatr Res. 2000;  47 36-42
• 23 Gournay V, Roze J C, Kuster A et al.. Prophylactic ibuprofen versus placebo in very premature infants: a randomised, double-blind, placebo-controlled trial.  Lancet. 2004;  364 1939-1944
• 24 Vanhaesebrouck S, Zonnenberg I, Vandervoort P, Bruneel E, Van Hoestenberghe M R, Theyskens C. Conservative treatment for patent ductus arteriosus in the preterm.  Arch Dis Child Fetal Neonatal Ed. 2007;  92 F244-F247
• 25 Vanhaesebrouck P, Allegaert K, Bottu J Extremely Preterm Infants in Belgium Study Group et al. The EPIBEL study: outcomes to discharge from hospital for extremely preterm infants in Belgium.  Pediatrics. 2004;  114 663-675
• 26 Costeloe K, Hennessy E, Gibson A T, Marlow N, Wilkinson A R. The EPICure study: outcomes to discharge from hospital for infants born at the threshold of viability.  Pediatrics. 2000;  106 659-671
• 27 Brooks J M, Travadi J N, Patole S K, Doherty D A, Simmer K. Is surgical ligation of patent ductus arteriosus necessary? The Western Australian experience of conservative management.  Arch Dis Child Fetal Neonatal Ed. 2005;  90 F235-F239
• 28 Hans D M, Pylipow M, Long J D, Thureen P J, Georgieff M K. Nutritional practices in the neonatal intensive care unit: analysis of a 2006 neonatal nutrition survey.  Pediatrics. 2009;  123 51-57
• 29 Jhaveri N, Moon-Grady A, Clyman R I. Early surgical ligation versus a conservative approach for management of patent ductus arteriosus that fail to close after indomethacin treatment. Pediatrics (in press)