Abstract
Background/Aims: Patent ductus arteriosus (PDA) is common in preterm infants and is inversely related to gestational age. The incidence is 40–55% in infants of 23–28 weeks gestation but drops to 0.1% for full term infants. PDA management appears to be variable; from conservative waiting to pharmacotherapy and surgery. We undertook a national survey among neonatologists to determine if there was any consensus regarding the management of PDAs.
Methods: We surveyed all 133 active neonatologists working in level 2 or 3 centres with 29 questions regarding the diagnosis and management of PDA. The results were reviewed with a descriptive analysis.
Results: Out of the 79%(105/133) who responded, 75% of neonatologists wanted echocardiographic confirmation before initiating treatment. 71% waited until the PDA became a clinical problem before initiating treatment. Prior to initiating pharmacotherapy, 78% of neonatologists assessed creatinine levels and 94% assessed platelet counts. 68% decreased fluid intake and 52% stopped feeding. Medical treatment is the first line of treatment for everyone. Indomethacin was the drug of choice with only 5% using ibuprofen. Only 31% of neonatologists used indomethacin prophylacticly. The dosage for indomethacin varied widely. Surgery is primarily done when medical treatment was contraindicated and/or after medical treatment had failed. Surgical ligation was performed by pediatric cardiac surgeons in 64% of centres and by pediatric general surgeons in 26% of centres.
Conclusion: Management of PDA varied across Canada. Echocardiographic conformation was sought before treatment. Similarly, the majority waited until the PDA became a clinical problem before intervention. Indomethacin was the first line of treatment. Creatinine and platelets were measured and fluid was restricted prior to treatment. Prophylactic indomethacin use was rare. Surgical ligations were done by pediatric surgeons. These findings suggest that a systematic approach to the management of PDA appears to be necessary so that treatment effects can be assessed.
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Bolster, E., Kakadekar, A. & Sankaran, K. 46 Diagnosis and Management of Patent Ductus Ateriosus in Premature Infants: A Canada Wide Survey of Neonatologists. Pediatr Res 58, 362 (2005). https://doi.org/10.1203/00006450-200508000-00075
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DOI: https://doi.org/10.1203/00006450-200508000-00075