A conservative treatment of patent ductus arteriosus in very low birth weight infants

Early haemodynamically significant patent ductus arteriosus does not predict future persistence in extremely preterm infants

“…In accordance with previous studies of infants born before 28 weeks of GA, the response to pharmacological treatment of PDA was poor and there was no change in mortality following treatment in this cohort . Being able to identify infants that will respond to pharmacological treatment at an early stage may, nonetheless, improve treatment outcomes in extremely preterm infants.…”

PDA: To treat or not to treat

“…While changes in respiratory management did occur during the study time period, they mainly occurred in a time that would not likely impact difference between the early targeted treatment and conservative management group. The authors found a significantly decreased risk for chronic lung disease in the conservative management group . Semberova et al recently illustrated spontaneous ductal closure in the majority of preterm neonates prior to discharge, with incidence of PDA inversely related to gestational age, in a cohort of infants managed with a conservative approach.…”

“…Kaempf reported increases in chronic lung disease and death after day 7 or chronic lung disease (as a combined outcome) following reduction in indomethacin use in a group of four affiliated nurseries, 28 in the conservative management group. 26 Semberova et al recently illustrated spontaneous ductal closure in the majority of preterm neonates prior to discharge, with incidence of PDA inversely related to gestational age, in a cohort of infants managed with a conservative approach. While the duration of ductal patency increased with decreasing gestational age, with a median age at ductal closure of 71 days in patients <26 weeks of GA, they identified no significantly increased risk of morbidities such as BPD or NEC (Figure 2).…”

“…Because of the widely held belief that treatment is beneficial, and therefore necessary, that natural history has been obscured by a lack of data on the trajectories of untreated preterm infants. Several recent studies, now including more than 1000 infants managed conservatively, have described the consequences of adoption of nonintervention strategies at individual centers . With few exceptions, studies have not demonstrated an increased risk of morbidity or mortality in association with marked reduction or elimination of use of medical or surgical intervention to close the ductus.…”

“…Several recent studies, now including more than 1000 infants managed conservatively, have described the consequences of adoption of nonintervention strategies at individual centers. [20][21][22][23][24][25][26][27] With few exceptions, studies have not demonstrated an increased risk of morbidity or mortality in association with marked reduction or elimination of use of medical or surgical intervention to close the ductus. Kaempf reported increases in chronic lung disease and death after day 7 or chronic lung disease (as a combined outcome) following reduction in indomethacin use in a group of four affiliated nurseries, 28 in the conservative management group.…”