Permissive tolerance of the patent ductus arteriosus may increase the risk of Chronic Lung Disease

Kaempf, Joseph W.; Huston, Robert K.; Wu, YingXing; Kaempf, A J; Wang, Lian; Grunkemeier, Gary L.; Mischel, Rebecca; Cohen, Howard C.; B, Freitag

doi:10.2147/rrn.s40306

Cited by 9 publications

(8 citation statements)

References 19 publications

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“…Numerous authors have reviewed the risks and benefits of medical and surgical intervention to promote ductal closure, as detailed elsewhere. 5,7,13,[28][29][30][31][32][33] Although surgical ligation has been deemed a "safe procedure" (with 92% survival at 30 days) 34 and continues to be an effective method of PDA closure, there is growing concern about long-term outcomes in preterm infants. A recent Scottish study 35 of 125 infants undergoing surgical ligation reported that at age 1 year, nearly one-third of the cohort was plagued by "neurodisability" (including CP, visual impairment, and hearing loss), which is similar to our findings in our children at age 2-3 years (28.2%; unadjusted OR, 2.724; P < .001).…”

Section: Discussionmentioning

confidence: 99%

Neurodevelopmental Outcomes of Premature Infants Treated for Patent Ductus Arteriosus: A Population-Based Cohort Study

Janz-Robinson

Walker

Abdel-Latif

et al. 2015

The Journal of Pediatrics

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Section: Discussionmentioning

confidence: 99%

Neurodevelopmental Outcomes of Premature Infants Treated for Patent Ductus Arteriosus: A Population-Based Cohort Study

Janz-Robinson

Walker

Abdel-Latif

et al. 2015

The Journal of Pediatrics

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“…Recently a new terminology "Permissive Tolerance of PDA" was introduced to describe a less aggressive, expectant management of PDA. This study reported significantly higher rate of chronic lung disease (48 % vs. 34 %, p<0.01) compared to control period, raising further questions about management of PDA [8]. In this review the authors will attempt to discuss these controversies and current trends in PDA management.…”

Section: Introductionmentioning

confidence: 89%

Management of Patent Ductus Arteriosus in Premature Infants

Bhat

Das

2014

Indian J Pediatr

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Patency of the ductus arteriosus is required for fetal survival in utero. In infants born prematurely, ductus fails to close and shunt reverses from left to right. Incidence of patent ductus arteriosus (PDA) is inversely proportional to the gestational age. A large PDA (>1.5 mm diameter) with left to right shunt in very low birth weight infants can cause pulmonary edema, congestive heart failure, pulmonary hemorrhage and increase the risk for bronchopulmonary dysplasia. Attempts to prevent or close the duct by pharmacological or surgical methods have not changed the morbidity or the long term outcome. Pharmacological treatment with indomethacin or ibuprofen is successful in 75 to 80 % of infants but its use also exposes these infants to undesirable side effects like gastrointestinal bleeding, perforation and necrotizing enterocolitis. Prophylactic therapy with indomethacin or ibuprofen to prevent PDA has not altered the morbidity or long term outcome. Currently, there is a dilemma as to how to treat, when to treat and whom to treat. Recent literature suggests a trial of conservative management during the first week followed by selective use of anti-inflammatory drugs. Surgical ligation is reserved for infants who fail medical therapy and still remain symptomatic. Spontaneous closure of the PDA has been reported in up to 40-67 % of very low birth weight (VLBW) infants by 7 d. In this review authors discuss these controversies and propose a more rational approach.

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“…With few exceptions, studies have not demonstrated an increased risk of morbidity or mortality in association with marked reduction or elimination of use of medical or surgical intervention to close the ductus. Kaempf reported increases in chronic lung disease and death after day 7 or chronic lung disease (as a combined outcome) following reduction in indomethacin use in a group of four affiliated nurseries, but this observation has not been replicated. Another cohort study of conservative management in 178 patients between 23 and 26 weeks o gestational age compared patients from 2009 to 2011, when 64% of patients were treated with indomethacin and 82% underwent ligation, with a second epoch from 2012 to 2014 where medical symptomatic interventions such as fluid restriction and diuretic use were implemented .…”

Section: Experience With Noninterventional Strategiesmentioning

confidence: 99%

“…[20][21][22][23][24][25][26][27] With few exceptions, studies have not demonstrated an increased risk of morbidity or mortality in association with marked reduction or elimination of use of medical or surgical intervention to close the ductus. Kaempf reported increases in chronic lung disease and death after day 7 or chronic lung disease (as a combined outcome) following reduction in indomethacin use in a group of four affiliated nurseries, 28 in the conservative management group. 26 Semberova et al recently illustrated spontaneous ductal closure in the majority of preterm neonates prior to discharge, with incidence of PDA inversely related to gestational age, in a cohort of infants managed with a conservative approach.…”

Section: E Xperien Ce With Noninterventi Onal S Tr Ateg Ie Smentioning

confidence: 99%

PDA: To treat or not to treat

Bhombal

Benitz

2019

Congenital Heart Disease

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Management of patent ductus arteriosus in extremely preterm infants remains a topic of debate. Treatment to produce ductal closure was widely practiced until the past decade, despite lack of evidence that it decreases morbidities or mortality. Meta‐analyses of trials using nonsteroidal anti‐inflammatory drugs have shown effectiveness in accelerating ductal closure, but no reduction in neonatal morbidities, regardless of agent used, indication, timing, gestational age, or route of administration. Surgical ligation closes the ductus but is associated with adverse effects. Recent experience with conservative approaches to treatment suggest improved neonatal outcomes and a high rate of spontaneous ductal closure after discharge. Careful postdischarge follow‐up is important, however, because potential adverse effects of long‐standing aortopulmonary shunts may be an indication for catheter‐based ductal closure. Identification of extremely preterm infants at greatest risk of potential harm from a persistently patent ductus, who may benefit most from treatment are urgently needed.

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Permissive tolerance of the patent ductus arteriosus may increase the risk of Chronic Lung Disease

Cited by 9 publications

References 19 publications

Neurodevelopmental Outcomes of Premature Infants Treated for Patent Ductus Arteriosus: A Population-Based Cohort Study

Neurodevelopmental Outcomes of Premature Infants Treated for Patent Ductus Arteriosus: A Population-Based Cohort Study

Management of Patent Ductus Arteriosus in Premature Infants

PDA: To treat or not to treat

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