Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Reply to correspondence

Journal of Perinatology volume 42, pages 693–694 (2022)Cite this article

Subjects

We thank you for affording us the opportunity to response to the correspondence by Memon and Griffin written in relation to our PDA severity score (PDAsc) series of articles [1,2,3]. The complex relationship between PDA and chronic lung disease (CLD) in the neonatal literature is further complicated by clinical trials which are designed to be “pragmatic” for ease of recruitment but are inherently flawed for the following reasons: first, impurity of the study population based on imprecise adjudication of hemodynamic significance; second, study interventions are not always 100% effective, as Memom and Griffin correctly point out; and finally, efficacy is measured based on a diagnosis of CLD which once again is imprecise from a diagnostic perspective as it refers to the receipt of assisted respiratory support, which occur for a variety of reasons e.g. atrial level shunts, pulmonary vein disease, left heart diastolic dysfunction with pulmonary venous hypertension.

The authors rightly point out that some extremely premature infants are likely to benefit from selective targeted (rather than “aggressive”) treatment and PDAsc was developed to aid in the identification of the infants. Our study was not designed to establish, nor did we conclude, any causal relationship between PDA and CLD in this population, rather, it was an important association with the score that integrates echocardiography markers of haemodynamic significance, namely: shunt volume, pulmonary overcirculation, and left heart diastolic dysfunction with other clinical parameters to appraise risk in a comprehensive and holistic manner. We wish to highlight, however, that other PDA scores, based on comprehensive echocardiography-based appraisal of hemodynamic significance in the first 7 postnatal days, have been shown to be associated with later risk of CLD [4].

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Bussmann N, Smith A, Breatnach CR, McCallion N, Cleary B, Franklin O, et al. Patent ductus arteriosus shunt elimination results in a reduction in adverse outcomes: a post hoc analysis of the PDA RCT cohort. J Perinatol. 2021;41:1134–41.

    Article  Google Scholar 

  2. El-Khuffash A, Bussmann N, Breatnach CR, Smith A, Tully E, Griffin J, et al. A pilot randomized controlled trial of early targeted patent ductus arteriosus treatment using a risk based severity score (The PDA RCT). J Pediatr. 2021;229:127–33.

    Article  CAS  Google Scholar 

  3. El-Khuffash A, James AT, Corcoran JD, Dicker P, Franklin O, Elsayed YN, et al. A patent ductus arteriosus severity score predicts chronic lung disease or death before discharge. J Pediatr. 2015;167:1354–61.e1352.

    Article  Google Scholar 

  4. Rios DR, Martins FF, El-Khuffash A, Weisz DE, Giesinger RE, McNamara PJ. Early role of the atrial-level communication in premature infants with patent ductus arteriosus. J Am Soc Echocardiogr. 2021;34:423–32.e421.

    Article  Google Scholar 

  5. Mitra S, Scrivens A, von Kursell AM, Disher T. Early treatment versus expectant management of hemodynamically significant patent ductus arteriosus for preterm infants. Cochrane Database Syst Rev. 2020;12:CD013278.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neonatology, The Rotunda Hospital, Dublin, Ireland

    Afif EL-Khuffash

  2. Department of Paediatrics, The Royal College of Surgeons in Ireland, Dublin, Ireland

    Afif EL-Khuffash

  3. Division of Neonatology, Stead Family Children’s Hospital, Iowa City, IA, USA

    Patrick McNamara

  4. Department of Pediatrics, Cardiology, University of Iowa, Iowa City, IA, USA

    Patrick McNamara

  5. Department of Cardiology, University of Iowa, Iowa City, IA, USA

    Patrick McNamara

Authors
  1. Afif EL-Khuffash
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patrick McNamara
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AEK drafted the response. PM reviewed and edited the response.

Corresponding author

Correspondence to Afif EL-Khuffash.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

EL-Khuffash, A., McNamara, P. Reply to correspondence. J Perinatol 42, 693–694 (2022). https://doi.org/10.1038/s41372-021-01235-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-021-01235-y

Search

Advanced search

Quick links