Patent ductus arteriosus: are we treating the right ones?

Variability in the diagnosis of haemodynamically significant patent ductus arteriosus (hsPDA) can result in treating inconsequential PDAs and causes difficulty in interpreting clinical outcomes from the available literature. This study evaluates the echocardiogram parameters used to ascertain hsPDA in very low birth weight infants in a tertiary care centre in the UK. Extremely premature infants that received pharmacological or surgical treatment for a PDA were evaluated for basic characteristics, diagnostic echocardiograms, closure rates and eventual outcomes of persistent duct on follow-up.

Daniel Hickman
Foundation Year Doctor¹

Anupam Gupta
Consultant Neonatal Medicine² and Honorary Senior Lecturer³

Arin Mukherjee
Consultant Neonatal Medicine² and Honorary Senior Lecturer³
arin.mukherjee@mft.nhs.uk

¹Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust
²Department of Neonatology, St Mary’s Hospital, Manchester University NHS Foundation Trust
³University of Manchester

Hickman D., Gupta A., Mukherjee A. Patent ductus arteriosus: are we treating the right ones? Infant 2023; 19(6): 198-202.

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Keywords

haemodynamically significant patent ductus arteriosus (hsPDA); preterm infant; diagnostic echocardiogram; paracetamol; ibuprofen

Key points

Variability in the diagnosis of hsPDA is a widespread issue that may result in treating inconsequential PDAs with pharmacological agents.
Thirty-six patients were identified for evaluation. The detail on their diagnostic echocardiogram reports varied widely.
A consensus on hsPDA is required to establish uniformity in practice and allow future trials to improve clinical practice.

Also published in Infant:

VOLUME 18 ISSUE 5/SEPTEMBER 2022

The PAIR trial: is paracetamol the way forward in management of hsPDA?

Currently, intravenous (IV) ibuprofen is the only licensed medication for the medical treatment of patent ductus arteriosus (PDA) in the UK; however, there is emerging evidence to suggest that paracetamol may be a promising alternative with fewer side effects. The PAIR pilot trial is the first study in the UK to investigate the efficacy and safety of IV paracetamol in comparison to IV ibuprofen for the management of haemodynamically significant PDA (hsPDA) in preterm infants. This article describes the rationale for the use of paracetamol and the design of the PAIR pilot trial, which will help to inform a much larger future study.