Examining treatment options for patent ductus arteriosus

June 19, 2020

Persistent patent ductus arteriosus is tied to increased mortality and many respiratory mortalities. A report compares treatment with ibuprofen versus no intervention.

In preterm infants persistent patent ductus arteriosus (PDA) is linked with increased mortality as well as respiratory morbidities like bronchopulmonary dysplasia. An investigation in JAMA Pediatrics compared the effectiveness of no intervention versus an oral ibuprofen treatment.1

Investigators ran a randomized, double-blind, placebo-controlled, noninferiority clinical trial that was conducted on preterm infants who were a gestational age of 23 to 30 weeks and had hemodynamically significant PDA (ductal size >1.5 mm plus respiratory support) that was diagnosed between postnatal days 6 and 14. Participants were stratified by gestational age and randomly assigned to receive a placebo or oral ibuprofen (initial dose of 10 mg/kg followed by a 5-mg/kg dose after 24 hours and a second 5-mg/kg dose after 48 hours).

One hundred forty-six infants were included in the study, with 72 assigned to the nonintervention arm and 70 assigned to the ibuprofen treatment group. Patent ductus arteriosus closure rates at 1 week following randomization were found to be significantly higher with ibuprofen than nonintervention in infants at gestational age 27 to 30 weeks. The findings were not significant at gestational age 23 to 26 weeks however. Additionally, the ductal closure rates before hospital discharge and device closure were not significantly different between the 2 groups. Two infants in the ibuprofen group were given backup treatment. No backup treatment was needed for any infant in the placebo group.

The researchers concluded that nonintervention was noninferior when compared with ibuprofen treatment of hemodynamically significant PDA.

Reference:

1. Sung S, Lee M, Ahn S, Chang Y, Park W. Effect of nonintervention vs oral ibuprofen in patent ductus arteriosus in preterm infants. JAMA Pediatr. June 15, 2020. Epub ahead of print. doi:10.1001/jamapediatrics.2020.1447