Indomethacin for symptomatic patent ductus arteriosus in preterm infants

Evans, Peter; O’Reilly, Deirdre; Flyer, Jonathan N.; Mitra, Souvik; Soll, Roger F.

doi:10.1002/14651858.cd013133

Cited by 7 publications

(10 citation statements)

References 44 publications

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“…Most RCTs aim at the efficacy to close the PDA and may be underpowered to estimate the impact on neonatal mortality or major morbidities [ 158 ]. Therefore, all Cochrane meta-analyses on the different pharmacological treatment options (indomethacin, ibuprofen or paracetamol (acetaminophen) targeting cyclooxygenase-I) failed to show an effect on mortality or BPD despite being effective in PDA closure [ 161 , 162 , 163 , 164 , 165 ]. A recent network meta-analysis evaluated RCTs regarding the different pharmacological interventions (indomethacin, ibuprofen, paracetamol (acetaminophen) or placebo) and found no difference in mortality or morbidities even compared to the placebo but higher rates of side effects as oliguria, especially in indomethacin and ibuprofen [ 166 ].…”

Section: What Is the Evidence For?mentioning

confidence: 99%

Evidence for the Management of Bronchopulmonary Dysplasia in Very Preterm Infants

2021

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Background: Very preterm birth often results in the development of bronchopulmonary dysplasia (BPD) with an inverse correlation of gestational age and birthweight. This very preterm population is especially exposed to interventions, which affect the development of BPD. Objective: The goal of our review is to summarize the evidence on these daily procedures and provide evidence-based recommendations for the management of BPD. Methods: We conducted a systematic literature research using MEDLINE/PubMed on antenatal corticosteroids, surfactant-replacement therapy, caffeine, ventilation strategies, postnatal corticosteroids, inhaled nitric oxide, inhaled bronchodilators, macrolides, patent ductus arteriosus, fluid management, vitamin A, treatment of pulmonary hypertension and stem cell therapy. Results: Evidence provided by meta-analyses, systematic reviews, randomized controlled trials (RCTs) and large observational studies are summarized as a narrative review. Discussion: There is strong evidence for the use of antenatal corticosteroids, surfactant-replacement therapy, especially in combination with noninvasive ventilation strategies, caffeine and lung-protective ventilation strategies. A more differentiated approach has to be applied to corticosteroid treatment, the management of patent ductus arteriosus (PDA), fluid-intake and vitamin A supplementation, as well as the treatment of BPD-associated pulmonary hypertension. There is no evidence for the routine use of inhaled bronchodilators and prophylactic inhaled nitric oxide. Stem cell therapy is promising, but should be used in RCTs only.

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Section: What Is the Evidence For?mentioning

confidence: 99%

Evidence for the Management of Bronchopulmonary Dysplasia in Very Preterm Infants

2021

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“…25 While further studies are needed to make definitive conclusions, some authors suggest maintaining oxygen saturation targets between 88% and 92%, and a higher alarm limit of 96%. 26 [87][88][89] Possible benefit in a subset of extremely premature infants. 95,97 Bronchodilators Management Improves short term lung mechanics by increasing compliance, and decreasing pulmonary resistance by dilating smaller airways with muscular atrophy Lack of evidence supporting use for management of BPD.…”

Section: Oxygen Saturation Targetsmentioning

confidence: 99%

“…[84][85][86] Multiple RCTs designed to evaluate pharmacological ductal closure have failed to show a reduction in risk of BPD. [87][88][89] A randomized controlled non-inferiority trial examining ibuprofen treatment compared with non-intervention for PDA closure found that the non-intervention group was not inferior to the treatment group with regards to the incidence of BPD or death (non-inferiority margin −0.2, p=0.51). This may in part due to the low efficacy of ibuprofen closure particularly in infants born at 23-26 weeks.…”

Section: Patent Ductus Arteriosus (Pda) Closurementioning

confidence: 99%

An Update on the Prevention and Management of Bronchopulmonary Dysplasia

Hennelly¹,

Greenberg²,

Aleem³

2021

PHMT

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Bronchopulmonary dysplasia (BPD) is a common morbidity affecting preterm infants and is associated with substantial long-term disabilities. There has been no change in the incidence of BPD over the past 20 years, despite improvements in survival and other outcomes. The preterm lung is vulnerable to injuries occurring as a result of invasive ventilation, hyperoxia, and infections that contribute to the development of BPD. Clinicians caring for infants in the neonatal intensive care unit use multiple therapies for the prevention and management of BPD. Non-invasive ventilation strategies and surfactant administration via thin catheters are treatment approaches that aim to avoid volutrauma and barotrauma to the preterm developing lung. Identifying high-risk infants to receive postnatal corticosteroids and undergo patent ductus arteriosus closure may help to individualize care and promote improved lung outcomes. In infants with established BPD, outpatient management is complex and requires coordination from several specialists and therapists. However, most current therapies used to prevent and manage BPD lack solid evidence to support their effectiveness. Further research is needed with appropriately defined outcomes to develop effective therapies and impact the incidence of BPD.

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“…Both of the drugs are successful in promoting ductal closure in 70–80% of cases. However, severe adverse effects, such as gastrointestinal perforation, acute renal failure, and bleeding disorders have been reported [ 7 , 8 , 9 , 10 ]. Recent studies have demonstrated that paracetamol is effective in closing and constricting hsPDA [ 11 , 12 , 13 ] with a better safety profile [ 13 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Platelet Count and Volume and Pharmacological Closure with Paracetamol of Ductus Arteriosus in Preterm Infants

et al. 2022

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Background: Low platelet count might promote resistance to pharmacological closure with indomethacin and ibuprofen of a hemodynamically significant patent ductus arteriosus (hsPDA). However, no studies have investigated if this occurs with paracetamol. Methods: We retrospectively assessed the correlation between platelet count, mean platelet volume (MPV), and plateletcrit (PCT), as well as the effectiveness of paracetamol in closing hsPDA in infants born at 23+0–31+6 weeks of gestation who were treated with 15 mg/kg/6 h of i.v. paracetamol for 3 days. Results: We studied 79 infants: 37 (47%) Had closure after a course of paracetamol and 42 (53%) did not. Platelet count and PCT did not correlate with paracetamol success or failure in closing hsPDA, while MPV was lower at birth (10.7 ± 1.4 vs. 9.5 ± 1.1; p < 0.001) and prior to starting therapy (11.7 ± 1.9 vs. 11.0 ± 1.6; p = 0.079) in refractory infants. Regression analysis confirmed that the low MVP measured prior to starting the treatment increased the risk of hsPDA paracetamol closure failure (OR 1.664, 95% CI 1.153–2.401). Conclusions: The greater MPV correlated positively with the effectiveness of paracetamol in closing hsPDA, while platelet count and PCT did not influence closure rates. Additional studies are needed to confirm our results.

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Indomethacin for symptomatic patent ductus arteriosus in preterm infants

Cited by 7 publications

References 44 publications

Evidence for the Management of Bronchopulmonary Dysplasia in Very Preterm Infants

Evidence for the Management of Bronchopulmonary Dysplasia in Very Preterm Infants

An Update on the Prevention and Management of Bronchopulmonary Dysplasia

Platelet Count and Volume and Pharmacological Closure with Paracetamol of Ductus Arteriosus in Preterm Infants

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