Slaughter Jonathan L, Reagan Patricia B, Bapat Roopali V, Newman Thomas B, Klebanoff Mark A
Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH, USA.
Eur J Pediatr. 2016 Jun;175(6):775-83. doi: 10.1007/s00431-016-2705-y. Epub 2016 Feb 15.
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.
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.
• 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.
我们通过基于网络的调查对美国46家儿童医院的新生儿治疗主导情况进行了调研，以确定关于吲哚美辛预防、非甾体抗炎药（NSAID）治疗及动脉导管未闭（PDA）结扎的当地偏好和关注点。我们收到了100%的调查回复（N = 46）。28%的新生儿重症监护病房（NICU）报告了预防性使用吲哚美辛的实践指南，39%报告了NSAID治疗PDA的指南，27%报告了手术结扎的指南。受访者指出，在吲哚美辛预防（33%）、NSAID治疗（70%）和PDA结扎（73%）方面存在机构内实践差异。大多数机构未开具吲哚美辛预防处方（72%）。对于PDA治疗，吲哚美辛比布洛芬更受青睐（80%）。我们通过与儿科健康信息系统（PHIS）数据库中记录的计费数据进行比较，验证了我们的调查结果，发现调查回复与当地计费数据直接相关（p < 0.0001）。在通常不使用NSAIDs进行PDA闭合或手术PDA结扎的机构中，最常被提及的原因是缺乏其改善长期预后有效性的证据以及治疗相关不良反应的风险。
美国儿童医院的医疗服务提供者在预防性使用吲哚美辛、NSAID治疗或PDA结扎方面未达成共识。缺乏证据和安全担忧起着重要作用。
• NSAIDs和手术PDA结扎在预防早产儿脑室内出血（IVH）和闭合PDA方面有效，但尚未证明能改善长期呼吸、神经发育或死亡率预后。新发现：• 吲哚美辛预防、NSAID和手术PDA治疗的实践偏好在机构间和机构内均存在差异。缺乏治疗有效性和不良反应风险是主要关注点。
