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Eur J Pediatr. 2016 Jun;175(6):775-83. doi: 10.1007/s00431-016-2705-y. Epub 2016 Feb 15.

Nonsteroidal anti-inflammatory administration and patent ductus arteriosus ligation, a survey of practice preferences at US children's hospitals.

Author information

1
Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA. Slaughter.84@osu.edu.
2
Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH, USA. Slaughter.84@osu.edu.
3
Department of Economics and Center for Human Resource Research, The Ohio State University, Columbus, OH, USA.
4
Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH, USA.
5
Departments of Epidemiology and Biostatistics and Pediatrics, University of California, San Francisco, CA, USA.
6
Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.

Abstract

We surveyed neonatal leadership at 46 US children's hospitals via web-based survey to identify local preferences and concerns regarding indomethacin prophylaxis, nonsteroidal anti-inflammatory drug (NSAID) treatment, and patent ductus arteriosus (PDA) ligation. We received a 100 % survey response (N = 46). Practice guidelines for prophylactic indomethacin were reported at 28 % of NICUs, for NSAID treatment of PDA at 39 % and for surgical ligation at 27 %. Respondents noted intra-institutional practice variation for indomethacin prophylaxis (33 %), NSAID treatment (70 %), and PDA ligation (73 %). The majority of institutions did not prescribe indomethacin prophylaxis (72 %). For PDA treatment, indomethacin was preferred over ibuprofen (80 %). We validated our survey results via comparison with billing data as documented in the Pediatric Health Information System (PHIS) database, finding that survey responses directly correlated with local billing data (p < 0.0001). At institutions that did not typically administer NSAIDs for PDA closure or surgical PDA ligation, a lack of evidence for their effectiveness in improving long-term outcomes and the risk of treatment-associated adverse effects were the most often cited reasons.

CONCLUSION:

No consensus exists among providers at US children's hospitals regarding prophylactic indomethacin, NSAID treatment, or PDA ligation. Lack of evidence and safety concerns play a prominent role.

WHAT IS KNOWN:

• NSAIDs and surgical PDA ligation are efficacious in preventing intraventricular hemorrhage (IVH) and closing PDA in preterm infants, but have not been shown to improve long-term respiratory, neurodevelopmental, or mortality outcomes. What is New: • Practice preferences for indomethacin prophylaxis, NSAID, and surgical PDA treatment vary both among and within institutions. Lack of treatment effectiveness and the risk of adverse effects are major concerns.

KEYWORDS:

Drug utilization; Ibuprofen; Indomethacin; Intraventricular hemorrhage; Nonsteroidal anti-inflammatory drugs; Patent ductus arteriosus; Pharmacoepidemiology; Practice preference; Practice survey; Practice variation; Prematurity

PMID:
26879388
PMCID:
PMC5056586
DOI:
10.1007/s00431-016-2705-y
[Indexed for MEDLINE]
Free PMC Article

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