Management of patent ductus arteriosus in very preterm infants in England and Wales: a retrospective cohort study

Abstract

ObjectiveTo describe the diagnosis and treatment of patent ductus arteriosus (PDA) in infants born at <32 weeks’ gestational age (GA) in England and Wales between 2010 and 2017.Study designRetrospective cohort study using routinely recorded data from the National Neonatal Research Database of infants born at <32 weeks admitted to neonatal units in England and Wales from 2010 to 2017.ResultsAmong 58 108 infants born at <32 weeks’ GA, 28.3% (n=16 440) had a PDA diagnosed clinically or with echocardiographic confirmation. Of these, 34.8% (n=5721; 9.8% of total <32 weeks’ infants included) had PDA treatment including 7.6% (n=1255) with indomethacin, 23.5% (n=3857) with ibuprofen and 5.6% (n=916) with surgical closure. The highest incidence of PDA was among infants born at 24 and 25 weeks’ GA (70.2% and 70.8%, respectively), decreasing to 6.1% among infants born at 31 weeks’ GA. The percentage of infants with a PDA increased over the study period (25.5% in 2010 to 28.5% in 2017). The percentage of infants who received ibuprofen or indomethacin or had PDA surgery decreased from 41.3% in 2010 to 33.7% in 2017, with an increase in use of ibuprofen from 20.2% to 27.3% while use of indomethacin decreased from 20.0% to 8.8%. Surgical closure of PDA decreased from 9.1% to 3.0%. Indomethacin was used for median (IQR) 3 (2–5) days while ibuprofen was given for 3 (2-4) days, at a median of 8 and 10 days after birth, respectively; surgical treatment was used later at 33 (24–45) days after birth.ConclusionsIbuprofen is the preferred drug and surgical interventions are becoming less frequent for PDA closure among very preterm infants in England and Wales.Trial registration numberNCT03773289.

Trial of Selective Early Treatment of Patent Ductus Arteriosus with Ibuprofen

“…6 27 Intravenous ibuprofen using a standard dosing regimen was chosen as the intervention in our study because higher doses are usually only used when an infant is 7 days of age or older, and it was the most common treatment schedule for infants with a PDA in the United Kingdom at the time the study was designed. 28 Similarly, most units did not routinely repeat echocardiographic assessment after ibuprofen therapy with the intention of offering a second course if the PDA remained patent.…”

Trial of Selective Early Treatment of Patent Ductus Arteriosus With Ibuprofen

“…6,26 Intravenous ibuprofen administered within a standard dosing regimen was chosen as the intervention in our trial because higher doses are usually used only when an infant is 7 days of age or older, and it was the most common treatment schedule for infants with a PDA in the United Kingdom at the time the trial was designed. 27 Similarly, most units did not routinely repeat echocardiographic assessment after ibuprofen therapy with the intention of offering a second course if the PDA remained patent.…”

Personalized Evidence-Based Management of Patent Ductus Arteriosus in Preterm Infants

“…Similarly, an extensive database encompassing over 61,000 preterm infants from 280 NICUs demonstrated a decline in the incidence of PDA diagnosis from 51 to 38%, a reduction in pharmacological treatment for PDA from 32 to 18%, and a 5% decrease in the PDA ligation rate when findings were compared between the two periods of 2011-2015 and 2006-2010 [31]. These changes have been witnessed across various countries worldwide [32][33][34].…”