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Patent ductus arteriosus: how important to which babies?
1Department of Paediatrics, National Women's Hospital, Auckland, New Zealand.
Insights
Treating a patent ductus arteriosus in preterm infants with surgery or indomethacin showed no significant impact on mortality or lung disease. Early indomethacin may reduce brain bleeds.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Clinical Trials
Background:
- Patent ductus arteriosus (PDA) is common in preterm infants.
- PDA can lead to significant complications.
- Interventions aim to close PDA and prevent adverse outcomes.
Purpose of the Study:
- To review randomized controlled trials (RCTs) comparing surgical closure versus indomethacin for PDA in preterm infants.
- To assess the impact of these interventions on mortality, chronic lung disease, and other morbidities.
Main Methods:
- Systematic review and overview of 21 RCTs.
- Included trials with surgical closure or indomethacin therapy for PDA.
- All trials had backup treatment protocols for persistent PDA.
Main Results:
- No significant overall effect on mortality or chronic lung disease was found.
- A trend towards reduced chronic lung disease was observed in trials treating PDA at a presymptomatic stage.
- Early indomethacin treatment was associated with a reduced incidence of periventricular hemorrhage.
- PDA size at 3 days correlated with infant condition, not gestational age or birth weight.
- Infants with moderate-to-large PDA had lower blood pressure from 12 hours onward.
Conclusions:
- Current evidence does not support a significant benefit of surgical closure or indomethacin for PDA on mortality or chronic lung disease in preterm infants.
- Early indomethacin may offer a neuroprotective benefit by reducing periventricular hemorrhage.
- PDA size and hemodynamic significance are related to infant illness severity and impact blood pressure.
- Further research may be needed to identify optimal timing and patient selection for PDA interventions.
Abstract:
An overview is presented of 21 randomised controlled trials of either surgical closure of the ductus arteriosus or indomethacin therapy in preterm infants. All trials included backup treatment if the ductus arteriosus persisted. Overall, there is no significant effect on mortality or chronic lung disease. In trials treating at a presymptomatic stage, there is a trend to reduce the incidence of chronic lung disease. Early treatment with indomethacin reduces the incidence of periventricular haemorrhage. An ultrasound study of 110 very low birth weight infants showed ductus arteriosus size at 3 days to be related to factors reflecting the infants' condition (ventilation indices, blood product administration), but not to birth weight or gestational age. Infants with a moderate to large ductus arteriosus at 3 days had a significantly lower blood pressure from 12 h of age onwards than those with a closed or small ductuses.