These variations included different routes of administration intravenous or oral , doses standard dose, high dose or prolonged course , method of administration bolus dose or continuous infusion , and included other interventions carried out at the same time. Some trials compared drugs, doses or routes of administration against others, and some compared drugs with placebo or no treatment.
This means that the conclusions may only cautiously apply to modern intensive care and children at younger gestational age. Patent ductus arteriosus closed within one week of all interventions in A high dose of oral ibuprofen was associated with a greater chance of patent ductus arteriosus closure than a standard dose of intravenous ibuprofen odds ratio [OR] 3. A high dose of oral ibuprofen was also associated with a greater chance of patent ductus arteriosus closure than a standard dose of intravenous indometacin OR 2.
A standard dose of for intravenous indometacin was defined as 0. Infant mortality was reported in 46 studies with 3, infants. The incidence of death was In the network meta-analysis, a standard dose of oral ibuprofen ranked best preventing death, but there was no statistically significant difference between any of the treatment options neonatal mortality.
In these studies, a high dose of oral ibuprofen was not associated with an increased incidence of enterocolitis a bowel condition found in premature babies. NICE published interventional procedures guidance in on closing the duct using endovascular techniques, compared with open surgery.
A high dose of oral ibuprofen appears to give the highest chance of patent ductus arteriosus closure in premature babies. Concerns remain about the use of nonsteroidal anti-inflammatory drugs such as oral ibuprofen due to concerns about necrotising enterocolitis, but this study found no association in older children. There may be other considerations in clinical practice, such as the weight of the baby or other illnesses, and the conclusions of this study need to be considered in the context of current practice within the UK.
Controversies in Management of Patent Ductus Arterious in the Preterm Infant
Association of placebo, indomethacin, ibuprofen, and acetaminophen with closure of hemodynamically significant patent ductus arteriosus in preterm infants: a systematic review and meta-analysis. Cardiac Unit. Gandhi A. Patent ductus arteriosus.
Leppard L and Besant N. Neonatal Intensive Care Unit. NHS website. Congenital heart disease. London: Department of Health and Social Care; updated Endovascular closure of patent ductus arteriosus. Mitra, S.
Jama Volume Issue 12 , The authors have concluded that a high dose of oral ibuprofen is the most effective medical intervention to close the persistent patent ductus arteriosus. They recognise the limitations of giving oral ibuprofen or paracetamol in extremely low birth weight infants under 28 weeks of gestation, especially in first few days after birth because of the risk of necrotising enterocolitis. Oral high dose ibuprofen or paracetamol could be a viable option to treat patent ductus arteriosus in more mature infants at 30 weeks of gestation or more. However, more evidence is required on its safety and efficacy in extremely low birth weight infants before it could be recommended as the first-line option.
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Interventions for Persisting Ductus Arteriosus in the Preterm Infant | Michael Obladen | Springer
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Types PDA as consequence of preterm birth - described in this topic PDA in association with other congenital heart disease signs may be absent in first year of life associated conditions clubbing congenital ventricular septal defect coarctation of aorta Reference - European Society of Cardiology guideline on management of grown up congenital heart disease can be found in Eur Heart J Jun;24 11 OpenInNew see also Evaluation of the infant for congenital heart disease CHD.
Patent ductus arteriosus of the preterm infant. Managing the patent ductus arteriosus in the premature neonate: a new look at what we thought we knew. Semin Perinatol. Diagnosis of the preterm patent ductus arteriosus: clinical signs, biomarkers, or ultrasound? Patent ductus arteriosus. Patent ductus arteriosus in premature neonates. Synthesized Recommendation Grading System for DynaMed DynaMed systematically monitors clinical evidence to continuously provide a synthesis of the most valid relevant evidence to support clinical decision-making see 7-Step Evidence-Based Methodology OpenInNew.
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