Interventions for patent ductus arteriosus (PDA) in preterm infants: an overview of Cochrane Systematic Reviews

Abstract

Background Patent ductus arteriosus (PDA) is associated with significant morbidity and mortality in preterm infants. Several non‐pharmacological, pharmacological, and surgical approaches have been explored to prevent or treat a PDA. Objectives To summarise Cochrane Neonatal evidence on interventions (pharmacological or surgical) for the prevention of PDA and related complications, and interventions for the management of asymptomatic and symptomatic PDA in preterm infants. Methods We searched the Cochrane Database of Systematic Reviews on 20 October 2022 for ongoing and published Cochrane Reviews on the prevention and treatment of PDA in preterm (< 37 weeks' gestation) or low birthweight (< 2500 g) infants. We included all published Cochrane Reviews assessing the following categories of interventions: pharmacological therapy using prostaglandin inhibitor drugs (indomethacin, ibuprofen, and acetaminophen), adjunctive pharmacological interventions, invasive PDA closure procedures, and non‐pharmacological interventions. Two overview authors independently checked the eligibility of the reviews retrieved by the search, and extracted data from the included reviews using a predefined data extraction form. Any disagreements were resolved by discussion with a third overview author. Two overview authors independently assessed the methodological quality of the included reviews using the AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews) tool. We reported the GRADE certainty of evidence as assessed by the respective review authors using summary of findings tables. Main results We included 16 Cochrane Reviews, corresponding to 138 randomised clinical trials (RCT) and 11,856 preterm infants, on the prevention and treatment of PDA in preterm infants. One of the 16 reviews had no included studies, and therefore, did not contribute to the results. Six reviews reported on prophylactic interventions for the prevention of PDA and included pharmacological prophylaxis with prostaglandin inhibitor drugs, prophylactic surgical PDA ligation, and non‐pharmacologic interventions (chest shielding during phototherapy and restriction of fluid intake); one review reported on the use of indomethacin for the management of asymptomatic PDA; nine reviews reported on interventions for the management of symptomatic PDA, and included pharmacotherapy with prostaglandin inhibitor drugs in various routes and dosages, surgical PDA ligation, and adjunct therapies (use of furosemide and dopamine in conjunction with indomethacin). The quality of reviews varied. Two reviews were assessed to be high quality, seven reviews were of moderate quality, five of low quality, while two reviews were deemed to be of critically low quality. For prevention of PDA, prophylactic indomethacin reduces severe intraventricular haemorrhage (IVH; relative risk (RR) 0.66, 95% confidence interval (CI) 0.53 to 0.82; 14 RCTs, 2588 infants),...

Treatment of patent ductus arteriosus and short-term outcomes among extremely preterm infants: a multicentre cohort study

“…Moreover, previous evidence has shown that medical treatment is more effective in closing a PDA than no treatment. 35 Fourth, since there is no guideline for PDA management in China, there may be significant variability in clinical practices, which may bias the results. Finally, despite the fact that we made a rigorous adjustment for confounding factors, unmeasured confounders may still affect our results.…”

Instant Detection of Cerebral Blood Flow Changes in Infants with Congenital Heart Disease during Transcatheter Interventions

“…Previous studies found cerebral ultrasound Doppler useful in the evaluation of PDA in prematures [ 17 , 18 ]. PDA in premature infants is associated with morbidity and mortality but the prevention and treatment of the open duct is still a controversial and challenging topic [ 19 ]. The hemodynamic understanding of the transitional period of premature infants needs to be explored further.…”

Correlation between the Closure Time of Patent Ductus Arteriosus in Preterm Infants and Long-Term Neurodevelopmental Outcome

“…Sung et al showed that delayed ligation (after more than 2 weeks after birth) decreased the risk for mortality or morbidities in extremely preterm infants born at 23-25 weeks of gestation [37]. Therefore, as a method that can be performed immediately after the birth of preterm infants and is minimally invasive, the transcatheter closure of PDA for preterm infants weighing less than 2 kg has been reportedly successful in a small number of institutions [38][39][40]. Considering the optimization of outcomes for long-term neurodevelopment, we hope that new, feasible, and effective treatments for this PDA will become widespread in the future.…”