The objective of this study was to determine whether neonatal-perinatal fellowship programs (NFTPs) in the United States vary in indomethacin use for the management of patent ductus arteriosus (PDA) in ≤28 week gestational age infants at birth. A 53-item web-based survey was sent to 84 NFTP directors who received prenotification, followed 2 weeks later by a reminder letter. A total of 56 NFTP directors responded (67% maximum response rate). Wide variation exists in the maximum number of indomethacin courses used to close ductus, use of indomethacin for reopened PDA beyond 14 days, ductal closure definition, contraindications before consideration of indo-methacin, interventions for contraindications, and reported ductal closer rate after each indomethacin course. Indomethacin therapy for symptomatic PDA and short course of indomethacin are common practices. Indomethacin use for the management of PDA in premature infants varies among NFTP directors. Practice attitudes may explain variations in ductal closure and ligation rates. Because practice variations may have implications for long-term outcome of vulnerable premature infants, studies relevant to the management of PDA in premature infants are needed. KeywordsIndomethacin; Health care surveys; Premature infants Patent ductus arteriosus (PDA) is extremely common, occurring in 50-75% of infants ≤28 weeks gestational age (GA) [19]. PDA is associated with increased risk of necrotizing © Springer Science+Business Media, LLC 2007 sanjiv_amin@urmc.rochester.edu. NIH Public Access Author ManuscriptPediatr Cardiol. Author manuscript; available in PMC 2015 January 06. Published in final edited form as:Pediatr Cardiol. 2007 ; 28(3): 193-200. doi:10.1007/s00246-006-0093-1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript enterocolitis, chronic lung disease, pulmonary hemorrhage, and intraventricular hemorrhage (IVH) [10,12,24,34]. Indomethacin is often used as a first line of treatment for PDA, with reported response rates greater than 60% in premature infants. However, studies have failed to provide conclusive results regarding the optimum duration, specifically short course (three dose) versus prolonged course (more than three doses) of indomethacin therapy [9,20,21,26,32,33,37]. Evidence is insufficient to support or refute the use of multiple courses (two or more courses) of indomethacin for the management of persistent PDA [23]. In addition, randomized trials conducted to date have varied in their definition of ductal closure based on echocardiographic findings. These variations in echocardiographic definitions of ductal closure have relevance for the interpretation of response rates in the literature and the need for further treatment [10,13,14,20,26,28,32,33,35,37].Although an initial indomethacin course will produce PDA closure in 60-80% of premature infants, the PDA reopens later in 6-53% of infants who initially respond to indomethacin [14,17,22,30]. There also appears to be no consensus regarding the best approach for the managem...
Background: Immunization is a necessary component of well child services within public health. Despite the documented effectiveness of vaccines, some parents choose to refuse or delay immunization for their children. Adherence to different beliefs has affected immunization coverage in one Regional Health Authority in Southwest Alberta. Methods: This qualitative study involved exploratory, descriptive open-ended interviews with a sample of 47. The sample included people of Dutch ethnic background, Hutterites, and parents and practitioners who engage in alternative health beliefs and practices. Results: Major findings include: 1) among the Dutch, most noted their decision to refuse to immunize was based on religious beliefs; 2) the Hutterites' decision not to immunize was due to their experiences with adverse reactions but was further supported by their use of alternative health; and, 3) the alternative health group are more concerned with the safety of vaccines with regard to the short-and long-term effects on their children's health. Discussion: All three groups conveyed a common concern of child health and safety. Educational initiatives need to be implemented to allay parents' fears. Community development activities with individuals of the groups included here who support immunization will increase acceptance of immunization.
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