Key result
Cardiologists are ~48% more likely than neonatologists to believe PDA closure impacts premature infant outcomes.
Why the study?
PDA is highly prevalent in ELBW preterm infants with diverse management approaches, creating a need to evaluate practice variations and alignment between cardiologists and neonatologists.
Cross-Sectional (n=203)
Yes
Absolute Event Rate: 80% vs 54%
p-value: p=<0.001
Significant practice variations exist between neonatologists and cardiologists regarding the management of patent ductus arteriosus in extremely low birth weight infants, with cardiologists more likely to favor intervention.
Belief gaps between specialties may drive PDA management inconsistencies in ELBW infants; leaves open the need for outcome trials to resolve indications.
BACKGROUND: Patent ductus arteriosus (PDA) is highly prevalent in extremely low birth weight (ELBW), preterm infants. There are diverse management approaches for the PDA in ELBW infants. The objectives of this research were to identify current PDA management practices among cardiologists and neonatologists in the United States, describe any significant differences in management, and describe areas where practices align. METHODS: A survey of 10 questions based on the management of PDA in ELBW infants was conducted among 100 prominent neonatologists from 74 centers and 103 prominent cardiologists from 75 centers. Among the cardiologists, approximately 50% were interventionists who perform transcatheter PDA closures (TCPC). Fisher's exact test was performed to compare practice variations among neonatologists and cardiologists. A potentially biased audience including a combination of health care providers belonging to cardiology, neonatology, and surgery were also surveyed during the International PDA Symposium. The results of this survey were not included for statistical comparison, due to this audience being potentially influenced by the Symposium. RESULTS: Statistically significant differences were identified between neonatologists and cardiologists regarding the impact of PDA closure on morbidity and mortality, with 80% cardiologists responding that it does vs 54% of neonatologists (P < 0.001), the need for PDA closure (P < .001), and the preferred method of PDA closure if indicated (P < .001). There was agreement between neonatologists and cardiologists on symptomatic therapy; however more neonatologists favored watchful waiting over intervention in contrast to more cardiologists favoring intervention over observation (77% vs 95%, P < .001). Survey responses also identified a need for further training and research on TCPC. CONCLUSION: Neonatologists and cardiologists have notable differences in managing PDA, and continued discussion across cardiology and neonatology has the potential to facilitate more of a consensus on best management practices. Further investigation is needed to identify outcomes in transcatheter PDA closure, particularly in ELBW infants.
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Sathanandam et al. (2019) conducted a cross-sectional in Patent ductus arteriosus in extremely low birth weight infants (n=203). Cardiology specialty vs. Neonatology specialty was evaluated on Belief that PDA closure impacts morbidity and mortality (p=<0.001). Cardiologists were significantly more likely than neonatologists to believe that PDA closure impacts morbidity and mortality in extremely low birth weight infants (80% vs 54%, P<0.001).
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