@Article{chd.12729,
AUTHOR = {Shyam Sathanandam, Stephanie Whiting, Jorden Cunningham, David Zurakowski, Leah Apalodimas, B. Rush Waller, Ranjit Philip, Athar M. Qureshi},
TITLE = {Practice variation in the management of patent ductus arteriosus in extremely low birth weight infants in the United States: Survey results among cardiologists and neonatologists},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {14},
YEAR = {2019},
NUMBER = {1},
PAGES = {6--14},
URL = {http://www.techscience.com/schd/v14n1/38751},
ISSN = {3071-1738},
ABSTRACT = {<b>Background:</b> 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.<br/>
<b>Methods:</b> 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.<br/>
<b>Results:</b> 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 < .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.<br/>
<b>Conclusion:</b> 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.},
DOI = {10.1111/chd.12729}
}