Surgical versus medical treatment with cyclooxygenase inhibitors for symptomatic patent ductus arteriosus in preterm infants

Malviya, Manoj N; Ohlsson, Arne; Shah, Sachin S

doi:10.1002/14651858.cd003951.pub3

Cited by 94 publications

(36 citation statements)

References 64 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Surgical ligation is generally performed in patients in whom medical therapy to close the ductus arteriosus has failed or is contraindicated [19]. Infants subjected to surgical ligation of the PDA usually obtain definitive closure, but are exposed to anesthesia and may endure adverse effects such as vocal cord injury [2], scoliosis [30], and post-operative hypotension [7] and increased risk for adverse outcomes including neurodevelopmental delay [16], bronchopulmonary dysplasia [4], and ROP [19]. Respondents at 41% of centers indicated they typically do not perform surgical ligation with noted practice variation between providers at 73%.…”

Section: Discussionmentioning

confidence: 99%

“…These therapies are efficacious in preventing IVH and closing PDA, respectively, but have not been shown to improve long term respiratory, neurodevelopmental, or mortality outcomes [8, 10, 15, 19, 23, 25]. In addition, the risk for long-term adverse effects following treatment of developing preterm infants with NSAIDs has not been fully evaluated [31, 33] and surgical ligation of PDA has been associated with increased bronchopulmonary dysplasia (BPD) and neurodevelopmental delay [4, 5, 16, 18, 22].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Nonsteroidal anti-inflammatory administration and patent ductus arteriosus ligation, a survey of practice preferences at US children’s hospitals

et al. 2016

View full text Add to dashboard Cite

We surveyed neonatal leadership at 46 US children's hospitals via web-based survey to identify local preferences and concerns regarding indomethacin prophylaxis, non-steroidal anti-inflammatory drug (NSAID) treatment, and patent ductus arteriosus (PDA) ligation. We received a 100% survey response (N=46). Practice guidelines for prophylactic indomethacin were reported at 28% of NICUs, for NSAID treatment of PDA at 39%, and for surgical ligation at 27%. Respondents noted intra-institutional practice variation for indomethacin prophylaxis (33%), NSAID treatment (70%), and PDA ligation (73%). The majority of institutions did not prescribe indomethacin prophylaxis (72%). For PDA treatment, indomethacin was preferred over ibuprofen (80%). We validated our survey results via comparison with billing data as documented in the Pediatric Health Information System (PHIS) database, finding that survey responses directly correlated with local billing data (p<0.0001). At institutions that did not typically administer NSAIDs for PDA closure or surgical PDA ligation, a lack of evidence for their effectiveness in improving long-term outcomes and the risk of treatment-associated adverse effects were the most often cited reasons. Conclusion No consensus exists among providers at U.S. children’s hospitals regarding prophylactic indomethacin, NSAID treatment, or PDA ligation. Lack of evidence and safety concerns play a prominent role.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nonsteroidal anti-inflammatory administration and patent ductus arteriosus ligation, a survey of practice preferences at US children’s hospitals

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Neither individual trials nor meta-analyses have demonstrated long-term benefits of measures to close the PDA. Cochrane reviews of prophylactic surgical ligation,19 indomethacin20 or ibuprofen,21 of PDA treatment with indomethacin22 or ibuprofen,23 or of surgical versus medical PDA closure24 all found that benefits were limited to ductal closure, fewer ductal ligations, and – with prophylactic indomethacin – less IVH (IVH > grade II) and periventricular leukomalacia 20. These neuroimaging effects were not associated with better neurodevelopmental outcomes.…”

mentioning

confidence: 99%

Patent ductus arteriosus: to treat or not to treat?

Benitz

2011

Arch Dis Child Fetal Neonatal Ed

View full text Add to dashboard Cite

Persistent patency of the ductus arteriosus in the preterm infant is associated with numerous morbidities, including higher rates of bronchopulmonary dysplasia and increased mortality. These strong associations have led to widespread use of cyclooxygenase inhibitors and surgical ligation to achieve ductal closure in the expectation that closing the ductus will reduce these complications. Each of these interventions has its own associated adverse effects. Neither individual randomised controlled trials nor meta-analyses of those trials have been able to demonstrate longterm benefi ts of these treatments despite their effi cacy in inducing ductal closure and reducing the need for ductal ligation. Despite the potential shortcomings of those trials, they provide substantial cumulative evidence that early, routine treatment to close a persistently patent ductus arteriosus in preterm infants does not improve outcomes and should therefore be abandoned. Future trials of these interventions for patent ductus management should address different questions. Persistence of ductal patency should be considered a sign of rather than a direct cause of the several morbidities with which it is clearly associated. Practitioners should tolerate ductal patency and learn to manage its causes and consequences rather than focusing on achievement of ductal closure.

show abstract

“…Other remaining questions regarding PDA treatment include the optimal timing of treatment [9,10] and subsequent long-term outcome [11,12]. …”

Section: Introductionmentioning

confidence: 99%

Patent Ductus Arteriosus Treatment in Very Preterm Infants: A European Population-Based Cohort Study (EPICE) on Variation and Outcomes

Bonamy

Guðmundsdóttir²,

Maier³

et al. 2017

Neonatology

View full text Add to dashboard Cite

Background: Spontaneous closure of patent ductus arteriosus (PDA) occurs frequently in very preterm infants and despite the lack of evidence for treatment benefits, treatment for PDA is common in neonatal medicine. Objectives: The aim of this work was to study regional variations in PDA treatment in very preterm infants (≤31 weeks of gestation), its relation to differences in perinatal characteristics, and associations with bronchopulmonary dysplasia (BPD) and survival without major neonatal morbidity. Methods: This was a population-based cohort study in 19 regions in 11 European countries conducted during 2011 and 2012. A total of 6,896 infants with data on PDA treatment were included. The differences in infant characteristics were studied across regions using a propensity score derived from perinatal risk factors for PDA treatment. The primary outcomes were a composite of BPD or death before 36 weeks postmenstrual age, or survival without major neonatal morbidity. Results: The proportion of PDA treatment varied from 10 to 39% between regions (p < 0.001), and this difference could not be explained by differences in perinatal characteristics. The regions were categorized according to a low (<15%, n = 6), medium (15-25%, n = 9), or high (>25%, n = 4) proportion of PDA treatment. Infants treated for PDA, compared to those not treated, were at higher risk of BPD or death in all regions, with an overall propensity score adjusted risk ratio of 1.33 (95% confidence interval 1.18-1.51). Survival without major neonatal morbidity was not related to PDA treatment. Conclusions: PDA treatment varies largely across Europe without associated variations in perinatal characteristics or neonatal outcomes. This finding calls for more uniform guidance for PDA diagnosis and treatment in very preterm infants.

show abstract

Surgical versus medical treatment with cyclooxygenase inhibitors for symptomatic patent ductus arteriosus in preterm infants

Abstract: There are insufficient data to conclude whether surgical ligation or medical treatment with indomethacin is preferred as the initial treatment for symptomatic PDA in preterm infants.

Cited by 94 publications

References 64 publications

Nonsteroidal anti-inflammatory administration and patent ductus arteriosus ligation, a survey of practice preferences at US children’s hospitals

Nonsteroidal anti-inflammatory administration and patent ductus arteriosus ligation, a survey of practice preferences at US children’s hospitals

Patent ductus arteriosus: to treat or not to treat?

Patent Ductus Arteriosus Treatment in Very Preterm Infants: A European Population-Based Cohort Study (EPICE) on Variation and Outcomes

Contact Info

Product

Resources

About