Patency of the ductus arteriosus in the premature infant: is it pathologic? Should it be treated?

Laughon, Matthew M.; Simmons, Michael; Bose, Carl

doi:10.1097/00008480-200404000-00005

Cited by 139 publications

(99 citation statements)

References 22 publications

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“…Second, the size of the PDA, as determined by the PDA:LPA ratio in the first 4 days of life has a strong predictive ability to identify neonates at risk of developing a sPDA that will require closure, excluding neonates not in need of treatment. 9 Risk stratification of this population using this approach may allow clinicians to develop a simple protocol for imaging and early intervention. Finally, by treating only the highest risk neonates at an early time point, complications from prophylactic treatment are minimized and therapeutic efficacy optimized.…”

Section: Discussionmentioning

confidence: 99%

“…8 Therefore, it is generally believed that early closure of a PDA in very low BW neonates may prevent these morbidities, resulting in aggressive closure of the PDA either medically or by surgical ligation by many physicians. However, Laughon et al 9 have suggested after a detailed review of DA closure and outcomes that prevention and/or treatment of a PDA have not decreased the associated morbidities, suggesting aggressive closure should not be a standard of care.…”

Section: Introductionmentioning

confidence: 99%

“…11 Furthermore, neonates receiving prophylactic indomethacin for DA closure did not demonstrate a decreased rate of BPD when compared with those receiving placebo and in whom the DA closed spontaneously. 9,12 Finally, indomethacin usage is not without potential adverse side effects. 13 Therefore, it is necessary to better characterize and define the ELBW population at-risk for developing an sPDA rather than to treat all ELBW neonates indiscriminately.…”

Section: Introductionmentioning

confidence: 99%

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Echocardiographic predictors of symptomatic patent ductus arteriosus in extremely-low-birth-weight preterm neonates

et al. 2010

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Objective: Identify echocardiographic parameters at p4 day postnatal that predict the subsequent need for closure of a clinically significant patent ductus arteriosus (sPDA) in extremely-low-birth-weight neonates (ELBW).Study Design: Serial echocardiograms obtained in 115 ELBW at p10 day postnatal were examined to estimate PDA size using the PDA:left pulmonary artery (LPA) diameter ratio: X1 indicated a large PDA, <1 but X0.5 moderate, and <0.5 small. Sensitivity, specificity, and positive predictive values (PPV) were determined for ELBW <27 weeks and X27 weeks gestational age.Result: Neonates with moderate to large PDA at p4 day had 15-times greater likelihood of requiring treatment for sPDA than those with a small PDA (95% confidence interval (CI): 5.6-41). Sensitivity, specificity and PPV of the PDA:LPA at <27 weeks was 80, 86 and 92%, respectively. Conclusion:A moderate to large PDA determined from the PDA:LPA ratio at p4 day postnatal identifies neonates <27 week gestation who subsequently require closure of a PDA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Echocardiographic predictors of symptomatic patent ductus arteriosus in extremely-low-birth-weight preterm neonates

et al. 2010

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“…However, the wisdom of closing a PDA has recently been challenged. [5][6][7][8][9][10] Potential role of PDA in complications of prematurity There is an association between PDA and the development of bronchopulmonary dysplasia (BPD). Initially, the increase in fluid filtration into the lungs as a result of high blood flow is cleared by an increase in lymphatic flow.…”

Section: Introductionmentioning

confidence: 99%

Patent ductus arteriosus in the preterm infant: to treat or not to treat?

Noori

2010

J Perinatol

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Pharmacological and/or surgical closure of a hemodynamically significant patent ductus arteriosus (PDA) in the very preterm infant has been the standard of care over the past few decades. However, the rationale for closure of PDA has recently been challenged. In this article, the factors that have fueled the controversy of the approach to the management of PDA and the gap in our knowledge are reviewed in detail. In addition, the pros and cons of the different treatment strategies applied in clinical care are evaluated with a focus on discussing the available evidence in the literature.

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“…8 Therefore, although these therapies are common, their use remains a source of continued debate. 9 We describe the current use of treatments to prevent or treat the PDA in preterm infants receiving care from a national consortium of neonatal care providers. We examine the association between different treatment strategies and neonatal outcome and review the variation in these practices between centers.…”

Section: Introductionmentioning

confidence: 99%

Treatment strategies to prevent or close a patent ductus arteriosus in preterm infants and outcomes

2007

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Objective: To describe the current use of treatments to prevent or treat patent ductus arteriosus (PDA) in preterm infants, examine the association between different treatment strategies and neonatal outcomes and review the variation in these practices between centers.Study design: Cohort study of infants born between 23 and 30 weeks gestation managed by the Pediatrix Medical Group from 1997 to 2004. We collected data on demographics, indomethacin and ligation, and outcomes of the following five groups: prophylactic indomethacin treatment: infants treated with indomethacin on day of life (DOL) 0 or 1; indicated indomethacin treatment: infants treated with indomethacin after DOL 1; PDA without treatment: infants with a PDA without report of treatment; ligation only: infants with a PDA ligation without use of indomethacin and no PDA: infants without a PDA and without treatment.Results: There were 6189 (18%) patients who received prophylactic indomethacin, 5690 (16%) patients received indicated treatment, 3886 (11%) patients had a PDA without treatment, 702 (2%) patients received ligation only and 18 136 (52%) patients had no PDA. In multivariate analysis, mortality among survivors to 2 days of age was lower (odds ratio (OR) 0.6, 95% confidence interval (CI) 0.5 to 0.7, P<0.01) and chronic lung disease, isolated intestinal perforation and severe retinopathy of prematurity (stages 3 and 4) were higher (OR 1.5, 95% CI 1.3 to 1.6, P<0.01; OR 1.5, 95% CI 1.1 to 2.0, P<0.01 and 1.4, 95% CI 1.2 to 1.6, P<0.01, respectively) in the indicated treatment group compared with the PDA without treatment group. The proportion of infants receiving prophylactic indomethacin among all infants and infants receiving indicated treatment among neonates with a report of a PDA varied by site from 0 to 59% (median 9.5%) and 0 to 100% (median 62%), respectively.Conclusions: Indomethacin use for intraventricular hemorrhage prevention and/or treatment of a PDA is common, but the selection of infants for treatment, and the decision of when and how to treat vary widely between centers. Our findings suggest the need for randomized, placebo-controlled trials of the effect of treatment of the PDA in preterm infants.

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Patency of the ductus arteriosus in the premature infant: is it pathologic? Should it be treated?

Cited by 139 publications

References 22 publications

Echocardiographic predictors of symptomatic patent ductus arteriosus in extremely-low-birth-weight preterm neonates

Echocardiographic predictors of symptomatic patent ductus arteriosus in extremely-low-birth-weight preterm neonates

Patent ductus arteriosus in the preterm infant: to treat or not to treat?

Treatment strategies to prevent or close a patent ductus arteriosus in preterm infants and outcomes

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