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

作者：Slaughter Jonathan L^*; Reagan Patricia B; Bapat Roopali V; Newman Thomas B; Klebanoff Mark A

来源：European Journal of Pediatrics, 2016, 175(6): 775-783.

DOI：10.1007/s00431-016-2705-y

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

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.

• 出版日期2016-6