Video abstract of “Permissive tolerance of the patent ductus arteriosus may increase the risk of chronic lung disease” published in the open access journal of Research and Report in Neonatology by Joseph W Kaempf, Robert Huston, YingXing Wu et al.
The patent ductus arteriosus is one of the most controversial topics in neonatology current management of the pda usually involves early closure therapies like endomethicin or surgical ligation however recent literature reviews note that there’s inadequate evidence that early aggressive pda treatment confers any long-term health benefit to premature infants hello i’m
Dr joe kempf a neonatologist and clinical researcher at providence st vincent medical center in portland oregon our group conducted a before after observational trial during which we changed our pda therapy from the traditional early closure treatment typical of most nicus to a less aggressive permissive strategy that included number one emphasis on nasal cpap
For respiratory support number two modest fluid restriction and number three restricted use of indomethacin to just those infants with large pdas requiring persistent nasal cpap or mechanical ventilation there were no other major changes in clinical care during this study our permissive pda therapy included 129 very low birth weight infants with a pda average
Gestational age 27 weeks at birth mean birth weight about 950 grams compared to similarly matched previous era very low birth weight infants our new approach to pda management resulted in endomethyl use declining from 79 percent to 26 of the infants and when it was given it was started later day 13 of life rather than day four and fewer doses were administered
And the surgical ligation rate declined modestly more infants were discharged home with a still patent ductus arteriosus but the majority of these closed spontaneously as outpatients there were no significant differences in respiratory support needs in either era except for the greater use of nasal cpap in the permissive pda time period so comparing traditional
Aggressive pda therapy clinical outcomes with our new permissive approach we found the following no significant differences in mortality interventricular hemorrhage periventricular leukomalacia retinopathy of prematurity necrotizing enterocolitis nosocomial infection or nicu length of stay however we did note a significant increase in the permissive pda era in
The chronic lung disease rate and the combined outcome of mortality or chronic lung disease we conclude that it’s biologically plausible that prolonged exposure to a significant pda could lead to more chronic lung disease and based upon our results we’ve modified our pda approach to a multi-variable staging assessment of the pda emphasizing careful serial physical
Exams assessment of clinical parameters such as respiratory support needs and specific echocardiogram findings we detail this in an explanatory table in the manuscript we’re now closely tracking our era 3 results to see if our pragmatic approach to pdas can minimize unnecessary treatments and iatrogenic events while recognizing those significant pdas that require
Closure to help avoid morbidities like chronic lung disease clearly a randomized controlled trial is needed to define the optimal timing and choice of pda therapies we believe our carefully documented observational quality improvement work the largest published experience to date describing permissive pda therapy has important findings of interest to neonatologists
We believe you will enjoy reading about our investigation thank you
Transcribed from video
Less aggressive management of PDA – Video abstract: 40306 By Dove Medical Press