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  • Letter to the Editor
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Reply to McNamara and Jain

Journal of Perinatology volume 33, page 249 (2013)Cite this article

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We thank Drs McNamara and Jain for their thoughtful letter and recognize their important contributions to our understanding of patent ductus arteriosus (PDA) physiology.1 On the whole, my co-authors and I agree with their salient points: (1) deleterious effects of a PDA are likely related to the magnitude and duration of the left-to-right shunt, and these data are generally not documented in PDA publications (including ours, although we made some progress in this regard), (2) small restrictive PDAs likely have been overtreated in past years (and our study specifically avoided this pitfall), (3) standardizing the definition of hemodynamic significance is paramount to refining rational PDA therapy.

A few points of clarification are important in regard to their questions. First, we clearly specify in the Methods that our investigation was prospectively designed to be 18 months. This was done not for convenience, but because we wanted a sufficient number of VLBW infants with PDAs treated with the new permissive protocol, to compare with the 139 control PDA infants born in the previous 36 months, a time period when cardiorespiratory therapy was traditional and relatively uniform. We were appropriately cautious as we wanted to minimize potential deleterious events related to untreated PDAs, yet have enough patients to make meaningful comparisons between Era 1 and Era 2. This was uncharted waters and there was some reticence. We think we struck a reasonable balance and our investigation is the largest published study that carefully documents a wide variety of NICU outcomes related to permissive PDA therapy.

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References

  1. McNamara PJ, Sehgal A . Towards rational management of the patent ductus arteriosus: the need for disease staging. Arch Dis Child Fetal Neonatal Ed 2007; 92: F424–F427.

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  2. Sosenko IR, Fajardo F, Claure N, Bancalari E . Timing of the patent ductus arteriosus and respiratory outcome in premature infants: a double-blind randomized controlled trial. J Pediatr 2012; 160: 929–935.

    Article  Google Scholar 

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  1. Providence St Vincent Medical Center NICU, Portland, OR, USA

    J W Kaempf

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  1. J W Kaempf
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Correspondence to J W Kaempf.

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Kaempf, J. Reply to McNamara and Jain. J Perinatol 33, 249 (2013). https://doi.org/10.1038/jp.2012.106

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