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Patent ductus arteriosus in extremely preterm infants receiving phototherapy: does shielding the chest make a
Javeed Travadi1, Karen Simmer, James Ramsay
1Women's and Children's Health Service, Subiaco, WA, Australia. javeed.travadi@hnehealth.nsw.gov.au
Insights
Chest shielding during phototherapy did not reduce the incidence or severity of patent ductus arteriosus (PDA) in extremely preterm infants. This study found no significant differences between infants who received chest shielding and those who did not.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Clinical Trials
Background:
- Patent ductus arteriosus (PDA) is a frequent complication in extremely preterm infants, linked to higher mortality and morbidity.
- Phototherapy, commonly used for neonatal jaundice, has been associated with an increased risk of PDA.
- Previous research suggested chest shielding during phototherapy might mitigate PDA risk.
Purpose of the Study:
- To investigate whether chest shielding during phototherapy can decrease the occurrence and severity of PDA in extremely preterm infants.
- To evaluate the impact of chest shielding on ductal parameters assessed via Doppler echocardiography.
Main Methods:
- A randomized clinical trial involving infants born before 29 weeks of gestation.
- Infants were stratified by gestational age (<27 weeks and 27-28 weeks) and randomized to receive phototherapy with or without chest shielding.
- Ductal parameters, including PDA incidence, ductal size, and left atrial/aortic root (LA/Ao) ratio, were measured by Doppler echocardiogram before and after phototherapy.
Main Results:
- No significant differences in PDA incidence, ductal size, or LA/Ao ratio were observed between the chest shielding and no shielding groups pre-phototherapy.
- Post-phototherapy, both groups showed similar rates of PDA incidence (12/27 vs. 13/27), ductal size (1.4 vs. 1.5 mm), and LA/Ao ratio (1.1 vs. 1.3).
- The study enrolled 54 infants, with comparable baseline ductal parameters across both arms.
Conclusions:
- Chest shielding during phototherapy did not demonstrate a significant effect on reducing the incidence or severity of patent ductus arteriosus in extremely preterm infants.
- The findings suggest that chest shielding is not an effective intervention for preventing PDA in this vulnerable population.
- Further research may be needed to explore other strategies for managing PDA risk associated with phototherapy in preterm neonates.
Background:
Patent ductus arteriosus (PDA), a common complication in extremely preterm infants, is associated with increased mortality and morbidity. Phototherapy has been associated with PDA, and one randomized, control trial has shown that shielding of the chest may decrease the risk of PDA.
Aim:
To examine if chest shielding reduces the incidence and severity of PDA in extremely preterm infants.
Study Design:
Randomized clinical trial of infants < 29 wk gestation (stratified into two groups: < 27 wk gestation and 27-28 wk gestation).
Methods:
Following written parental consent, eligible infants were randomized to receive phototherapy, with or without a chest shield. Ductal parameters were assessed by Doppler echocardiogram in all infants prior to starting phototherapy and at 48 h after initiation, or earlier if phototherapy was discontinued.
Results:
54 infants were enrolled in the study. The incidence of PDA (shield 19/27 vs no shield 21/27), ductal size (1.4 vs 1.0 mm) and left atrial/aortic root (LA/Ao) ratio (1.2 vs 1.3) were similar in the two groups pre-phototherapy. There was no difference between the groups post-phototherapy in incidence (shield 12/27 vs no shield 13/27), ductal size (1.4 vs 1.5 mm) or LA/Ao ratio (1.1 vs 1.3).
Conclusion:
Chest shielding did not alter the incidence or severity of PDA in our population of extremely preterm infants.