Conservative Management of Patent Ductus Arteriosus in Preterm Infants—A Systematic Review and Meta-Analyses Assessing Differences in Outcome Measures Between Randomized Controlled Trials and Cohort Studies

Hundscheid, Tim; Jansen, Esther J. S.; Onland, Wes; Kooi, Elisabeth M. W.; Andriessen, Peter; Boode, Willem P. de

doi:10.3389/fped.2021.626261

Cited by 26 publications

(14 citation statements)

References 37 publications

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“…However, several prior meta-analyses, 27 , 28 randomised clinical trials 9 , 10 , 11 and observational cohort studies 13 , 14 , 15 , 16 did not show improved outcomes with PDA treatment. There might be several reasons for the conflicting results.…”

Section: Discussionmentioning

confidence: 89%

“…There might be several reasons for the conflicting results. First, most studies 10 , 13 , 14 , 15 , 16 , 27 , 28 enrolled a large proportion of more mature preterm infants (28–32 weeks), and these infants were more likely to have spontaneous ductal closure and experience less haemodynamic effects from PDA. 29 Pooling data across gestational ages may mask the potential effect of PDA treatment on outcomes for the most immature population.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment of patent ductus arteriosus and short-term outcomes among extremely preterm infants: a multicentre cohort study

Qian,

Jiang,

et al. 2024

eClinicalMedicine

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Treatment of patent ductus arteriosus and short-term outcomes among extremely preterm infants: a multicentre cohort study

Qian,

Jiang,

et al. 2024

eClinicalMedicine

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“…Conservative management for PDA pertains to interventions including fluid restriction, diuretics, or ventilator adjustments [ 18 ]. Fluid restriction is commonly practiced in preterm infants with PDAs, particularly in the setting of enteral feedings due to the increased risk of necrotizing enterocolitis [ 19 ].…”

Section: Reviewmentioning

confidence: 99%

Closing the Gap: Investigation of Various Approaches in the Management of Patent Ductus Arteriosus

Ghouse,

Idrobo Zapata,

Kasam Shiva

et al. 2023

Cureus

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In preterm newborns with extremely low birth weights, patent ductus arteriosus (PDA), which is defined as a remnant connection between the aorta and pulmonary artery after 72 hours of birth, is frequently linked to substantial morbidity and mortality. If left untreated, a hemodynamically significant PDA (hsPDA) increases the risk for bronchopulmonary dysplasia, necrotizing enterocolitis, and intraventricular hemorrhage among other morbidities, and can even lead to death. While instances of patent ductus arteriosus (PDA) resolving on their own are frequent, the primary approach for managing PDA closure in premature infants involves pharmacological interventions, commonly utilizing indomethacin, ibuprofen, or paracetamol. However, with these pharmacological treatment options, there is an increased risk of renal toxicity, gastrointestinal bleeding, and reopening of PDA among other complications. If pharmacological interventions are not successful or contraindicated, PDA can be closed via transcatheter closure or surgical ligation. As with any medically invasive procedure, it is not without risks and can lead to long-term complications. This review explores the different management options and the benefits and outcomes of conservative management vs. active management in order to get one step closer to standardizing the treatment for PDA. With so much controversy surrounding the best management option, there is a lack of evidence to support one treatment method superior to the other in reducing overall mortality, and this needs to be explored further.

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“…1,6 In light of these observations, more stringent BPD definitions based on a systematic assessment of the need for respiratory therapy using pulse oximetry became more widely used in more recent randomized clinical trials (RCTs) to improve the consistency of the diagnosis of BPD across neonatal units. [14][15][16][17] Two large RCTs 18,19 that were specifically designed to determine the effect of high-dose enteral DHA supplementation during the neonatal period on BPD outcomes in preterm infants who were born before 29 weeks' gestation used such a systematic physiological BPD definition at 36 weeks' PMA. Contrary to the aforementioned hypothesis, both trials reported an overall increase of BPD with the use of DHA but an inconsistent association with BPD-free survival in analysis by gestational age (GA) and mode of delivery.…”

Section: Introductionmentioning

confidence: 99%

Association Between Enteral Supplementation With High-Dose Docosahexaenoic Acid and Risk of Bronchopulmonary Dysplasia in Preterm Infants

et al. 2023

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ImportanceHigh-dose docosahexaenoic acid (DHA), a long-chain polyunsaturated fatty acid, may affect the risk of bronchopulmonary dysplasia (BPD). However, high-level summative evidence supporting such clinical association in very preterm infants is lacking.ObjectiveTo examine the association between enteral supplementation with high-dose DHA during the neonatal period and the risk of BPD in preterm infants born at less than 29 weeks’ gestation.Data SourcesPubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, medRxiv, and ClinicalTrials.gov were searched from inception to August 1, 2022, for eligible articles with no language restrictions.Study SelectionRandomized clinical trials (RCTs) were eligible for inclusion (1) if their interventions involved direct administration of a minimum DHA supplementation of 40 mg/kg/d or breast milk or formula feeding of at least 0.4% of total fatty acids, and (2) if they reported data on either BPD, death, BPD severity, or a combined outcome of BPD and death.Data Extraction and SynthesisTwo investigators completed independent review of titles and abstracts, full text screening, data extraction, and quality assessment using the Cochrane Risk of Bias 2.0. Risk ratios (RRs) with 95% CIs were pooled using random-effect meta-analyses.Main Outcomes and MeasuresPrimary outcome was BPD using trial-specific definitions, which was further stratified for RCTs that used a more stringent BPD definition based on systematic pulse oximetry assessment at 36 weeks’ postmenstrual age. Other outcomes were BPD, death, BPD severity, or combined BPD and death.ResultsAmong the 2760 studies screened, 4 RCTs were included, which involved 2304 infants (1223 boys [53.1%]; mean [SD] gestational age, 26.5 [1.6] weeks). Enteral supplementation with high-dose DHA was associated with neither BPD (4 studies [n = 2186 infants]; RR, 1.07 [95% CI, 0.86-1.34]; P = .53; I2 = 72%) nor BPD or death (4 studies [n = 2299 infants]; RR, 1.04 [95% CI, 0.91-1.18]; P = .59; I2 = 61%). However, an inverse association with BPD was found in RCTs that used a more stringent BPD definition (2 studies [n = 1686 infants]; RR, 1.20 [95% CI, 1.01-1.42]; P = .04; I2 = 48%). Additionally, DHA was inversely associated with moderate-to-severe BPD (3 studies [n = 1892 infants]; RR, 1.16 [95% CI, 1.04-1.29]; P = .008; I2 = 0%).Conclusions and RelevanceResults of this study showed that enteral supplementation with high-dose DHA in the neonatal period was not associated overall with BPD, but an inverse association was found in the included RCTs that used a more stringent BPD definition. These findings suggest that high-dose DHA supplementation should not be recommended to prevent BPD in very preterm infants.

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Conservative Management of Patent Ductus Arteriosus in Preterm Infants—A Systematic Review and Meta-Analyses Assessing Differences in Outcome Measures Between Randomized Controlled Trials and Cohort Studies

Cited by 26 publications

References 37 publications

Treatment of patent ductus arteriosus and short-term outcomes among extremely preterm infants: a multicentre cohort study

Treatment of patent ductus arteriosus and short-term outcomes among extremely preterm infants: a multicentre cohort study

Closing the Gap: Investigation of Various Approaches in the Management of Patent Ductus Arteriosus

Association Between Enteral Supplementation With High-Dose Docosahexaenoic Acid and Risk of Bronchopulmonary Dysplasia in Preterm Infants

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