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Early screening for patent ductus arteriosus may reduce mortality in preterm infants
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Early screening echocardiography for patent ductus arteriosus in preterm infants was associated with lower rates of in-hospital mortality and pulmonary hemorrhage compared with no screening, researchers reported in JAMA.
Jean-Christophe Rozé, MD, PhD, and colleagues studied 847 preterm infants who underwent early screening echocardiography for patent ductus arteriosus within 3 days of birth and 666 preterm infants who were not screened. The infants were enrolled in the EPIPAGE 2 prospective cohort study and hospitalized at 68 neonatal ICUs in France from April to December 2011. The researchers also performed propensity-matched analysis of 605 pairs of infants who did or did not receive early screening.
The primary outcome was mortality between day 3 of hospitalization and discharge. Secondary outcomes included major neonatal morbidities such as pulmonary hemorrhage, severe bronchopulmonary dysplasia or cerebral lesions and necrotizing enterocolitis.
Infants who were screened were more likely to receive treatment for patent ductus arteriosus compared with infants who were not screened (55.1% vs. 43.1%; OR = 1.62; 95% CI, 1.31-2). The researchers calculated an absolute risk reduction of 12 events per 100 infants, according to the results.
The in-hospital mortality rate also was lower among infants who received early screening (14.2% vs. 18.5%; OR = 0.73; 95% CI, 0.54-0.98). Based on these results, 23 infants would need to be screened to prevent one death, the researchers wrote. The observed difference in mortality rate was primarily attributable to infants who did not receive treatment for patent ductus arteriosus (13.9% vs. 20.6%; OR = 0.62; 95% CI, 0.4-0.96). Exclusion of patients exhibiting clinical signs of patent ductus arteriosus did not alter the results, according to the researchers.
Infants who received early screening also were less likely to experience pulmonary hemorrhage (5.6% vs. 8.9%; OR = 0.6; 95% CI, 0.38-0.95). However, the two groups did not differ significantly with regard to the incidence of severe bronchopulmonary dysplasia or cerebral lesions or the incidence of necrotizing enterocolitis.
Results of instrumental variable analyses indicated a nonsignificant adjusted OR of 0.62 (95% CI; 0.37-1.04) for in-hospital mortality among infants who received early screening. The researchers noted that while this result did not confirm their findings, “this analysis provided a point estimate close to that from the primary analysis using propensity score matching and could still be considered supportive. … However, results of the instrumental variable analysis leave some ambiguity in the interpretation and longer-term evaluation is needed to provide clarity,” Rozé, from the department of neonatal medicine at Nantes University Hospital in Nantes, France, and colleagues concluded. – by Adam Taliercio
Disclosure: The researchers report no relevant financial disclosures.
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