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Patent Ductus Arteriosus in the Preterm Infant: A Survey of Clinical Practices in French Neonatal Intensive Care Units

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Abstract

Patent ductus arteriosus (PDA) is one of the most common problems in the care of premature infants, especially the extremely premature. There is no real consensus regarding the diagnostic criteria or treatment of a hemodynamically significant PDA. Its diagnosis, assessment, and treatment still remain challenges. Therefore, we investigated clinical practices in French tertiary neonatology centers regarding the management of PDA to compare their similarities and differences. We sent a questionnaire by email to the PDA specialist in every French tertiary neonatal intensive care unit. It contained 27 items regarding the unit’s structure, method of diagnosing PDA, and treatment choices. The completed questionnaire were returned via email and analyzed blindly. The questionnaire response rate was 87.5%, which allowed us to draw some conclusions regarding French clinical practices in the care of neonates with PDA. Although the diagnostic criteria are quite similar, the therapeutic practices are rather different across neonatal care units. We highlight the great variability in French clinical practices when it comes to treating PDA and underscore the necessity for harmonization of these practices, which could be achieved using multicenter, randomized studies to identify the advantages of one approach compared with another.

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References

  1. Alagarsamy S, Chhabra M, Gudavalli M, Nadroo AM, Sutija VG, Yugrakh D (2005) Comparison of clinical criteria with echocardiographic findings in diagnosing PDA in preterm infants. J Perinat Med 33:161–164

    Article  PubMed  Google Scholar 

  2. Aranda JV, Varvarigou A, Beharry K, Bansal R, Bardin C, Modanlou H et al (1997) Pharmacokinetics and protein binding of intravenous ibuprofen in the premature newborn infant. Acta Paediatr 86:289–293

    Article  PubMed  CAS  Google Scholar 

  3. Bose CL, Laughon MM (2007) Patent ductus arteriosus: lack of evidence for common treatments. Arch Dis Child Fetal Neonatal Ed 92:F498–F502

    Article  PubMed  Google Scholar 

  4. Brooks JM, Travadi JN, Patole SK, Doherty DA, Simmer K (2005) Is surgical ligation of patent ductus arteriosus necessary? The Western Australian experience of conservative management. Arch Dis Child Fetal Neonatal Ed 90:F235–F239

    Article  PubMed  CAS  Google Scholar 

  5. Chorne N, Leonard C, Piecuch R, Clyman RI (2007) Patent ductus arteriosus and its treatment as risk factors for neonatal and neurodevelopmental morbidity. Pediatrics 119:1165–1174

    Article  PubMed  Google Scholar 

  6. Costeloe K, Hennessy E, Gibson AT, Marlow N, Wilkinson AR (2000) The EPICure study: outcomes to discharge from hospital for infants born at the threshold of viability. Pediatrics 106:659–671

    Article  PubMed  CAS  Google Scholar 

  7. Davis P, Turner-Gomes S, Cunningham K, Way C, Roberts R, Schmidt B (1995) Precision and accuracy of clinical and radiological signs in premature infants at risk of patent ductus arteriosus. Arch Pediatr Adolesc Med 149:1136–1141

    PubMed  CAS  Google Scholar 

  8. Desfreres L, Zohar S, Morville P, Brunhes A, Chevret S, Pons G et al (2005) Dose-finding study of ibuprofen in patent ductus arteriosus using the continual reassessment method. J Clin Pharmacol Ther 30:121–132

    Article  Google Scholar 

  9. El Hajjar M, Vaksmann G, Rakza T, Kongolo G, Storme L (2005) Severity of the ductal shunt: a comparison of different markers. Arch Dis Child Fetal Neonatal Ed 90:F419–F422

    Article  PubMed  CAS  Google Scholar 

  10. Evans N (1993) Diagnosis of patent ductus arteriosus in the preterm newborn. Arch Dis Child 68:58–61

    Article  PubMed  CAS  Google Scholar 

  11. Evans N (2000) Echocardiography on neonatal intensive care units in Australia and New Zealand. J Paediatr Child Health 36:169–171

    Article  PubMed  CAS  Google Scholar 

  12. Gournay V, Roze JC, Kuster A, Daoud P, Cambonie G, Hascoet JM et al (2004) Prophylactic ibuprofen versus placebo in very premature infants: a randomised, double-blind, placebo-controlled trial. Lancet 364:1939–1944

    Article  PubMed  CAS  Google Scholar 

  13. Hirt D, Van Overmeire B, Treluyer JM, Langhendries JP, Marguglio A, Eisinger MJ et al (2008) An optimized ibuprofen dosing scheme for preterm neonates with patent ductus arteriosus, based on a population pharmacokinetic and pharmacodynamic study. Br J Clin Pharmacol 65:629–636

    Article  PubMed  CAS  Google Scholar 

  14. Kabra NS, Schmidt B, Roberts RS, Doyle LW, Papile L, Fanaroff A (2007) Neurosensory impairment after surgical closure of patent ductus arteriosus in extremely low birth weight infants: results from the Trial of Indomethacin Prophylaxis in Preterms. J Pediatr 150:229–234 34 e1

    Article  PubMed  CAS  Google Scholar 

  15. Kluckow M, Evans N (1995) Early echocardiographic prediction of symptomatic patent ductus arteriosus in preterm infants undergoing mechanical ventilation. J Pediatr 127:774–779

    Article  PubMed  CAS  Google Scholar 

  16. Kluckow M, Evans N, Osborn D, Paradisi M, Gill A (2008) Ductal diameter is determined more by postnatal age than gestational age. E-PAS 2008:635842.7

  17. Koch J, Hensley G, Roy L, Brown S, Ramaciotti C, Rosenfeld CR (2006) Prevalence of spontaneous closure of the ductus arteriosus in neonates at a birth weight of 1000 grams or less. Pediatrics 117:1113–1121

    Article  PubMed  Google Scholar 

  18. Kupferschmid C, Lang D, Pohlandt F (1988) Sensitivity, specificity and predictive value of clinical findings, m-mode echocardiography and continuous-wave Doppler sonography in the diagnosis of symptomatic patent ductus arteriosus in preterm infants. Eur J Pediatr 147:279–282

    Article  PubMed  CAS  Google Scholar 

  19. Laughon MM, Simmons MA, Bose CL (2004) Patency of the ductus arteriosus in the premature infant: is it pathologic? Should it be treated? Curr Opin Pediatr 16:146–151

    Article  PubMed  Google Scholar 

  20. Lyer P, Evans N (1994) Re-evaluation of the left atrial to aortic root ratio as a marker of patent ductus arteriosus. Arch Dis Child Fetal Neonatal Ed 70:F112–F117

    Article  Google Scholar 

  21. Madan JC, Kendrick D, Hagadorn JI, Frantz ID 3rd (2009) Patent ductus arteriosus therapy: impact on neonatal and 18-month outcome. Pediatrics 123:674–681

    Article  PubMed  Google Scholar 

  22. Malviya M, Ohlsson A, Shah S (2008) Surgical versus medical treatment with cyclooxygenase inhibitors for symptomatic patent ductus arteriosus in preterm infants. Cochrane Database Syst Rev CD003951

  23. McNamara PJ, Sehgal A (2007) Toward rational management of the patent ductus arteriosus: the need for disease staging. Arch Dis Child Fetal Neonatal Ed 92(6):F424–F427

    Article  PubMed  Google Scholar 

  24. Noori S, McCoy M, Friedlich P, Bright B, Gottipati V, Seri I et al (2009) Failure of ductus arteriosus closure is associated with increased mortality in preterm infants. Pediatrics 123:e138–e144

    Article  PubMed  Google Scholar 

  25. Raval MV, Laughon MM, Bose CL, Phillips JD (2007) Patent ductus arteriosus ligation in premature infants: who really benefits, and at what cost? J Pediatr Surg 42:69–75

    Article  PubMed  Google Scholar 

  26. Shah SS, Ohlsson A (2006) Ibuprofen for the prevention of patent ductus arteriosus in preterm and/or low birth weight infants. Cochrane Database Syst Rev CD004213

  27. Skelton R, Evans N, Smythe J (1994) A blinded comparison of clinical and echocardiographic evaluation of the preterm infant for patent ductus arteriosus. J Paediatr Child Health 30:406–411

    Article  PubMed  CAS  Google Scholar 

  28. Suzumura H, Nitta A, Tanaka G, Arisaka O (2001) Diastolic flow velocity of the left pulmonary artery of patent ductus arteriosus in preterm infants. Pediatr Int 43:146–151

    Article  PubMed  CAS  Google Scholar 

  29. Thomas RL, Parker GC, Van Overmeire B, Aranda JV (2005) A meta-analysis of ibuprofen versus indomethacin for closure of patent ductus arteriosus. Eur J Pediatr 164:135–140

    Article  PubMed  CAS  Google Scholar 

  30. Tschuppert S, Doell C, Arlettaz-Mieth R, Baenziger O, Rousson V, Balmer C et al (2008) The effect of ductal diameter on surgical and medical closure of patent ductus arteriosus in preterm neonates: size matters. J Thorac Cardiovasc Surg 135:78–82

    Article  PubMed  Google Scholar 

  31. Urquhart DS, Nicholl RM (2003) How good is clinical examination at detecting a significant patent ductus arteriosus in the preterm neonate? Arch Dis Child 88:85–86

    Article  PubMed  CAS  Google Scholar 

  32. Van Overmeire B (2007) Patent ductus arteriosus: how aggressive should we be? Neonatology 91:318

    Article  Google Scholar 

  33. Van Overmeire B, Allegaert K, Casaer A, Debauche C, Decaluwe W, Jespers A et al (2004) Prophylactic ibuprofen in premature infants: a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 364:1945–1949

    Article  PubMed  Google Scholar 

  34. Van Overmeire B, Chemtob S (2005) The pharmacologic closure of the patent ductus arteriosus. Semin Fetal Neonatal Med 10:177–184

    Article  PubMed  Google Scholar 

  35. Van Overmeire B, Smets K, Lecoutere D, Van de Broek H, Weyler J, Degroote K et al (2000) A comparison of ibuprofen and indomethacin for closure of patent ductus arteriosus. N Engl J Med 343:674–681

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank ORPHAN EUROPE for its help in recovering all of the “PDA referents” email addresses; all of the French pediatric and neonatal intensive care units (http:/www.gfrup.com/gfrup_annuaire.html) for answering the questionnaire; and Florence Babre and Michael Fayon for their help in the questionnaire design. Deep gratitude is also expressed for Luke Harper for help in editing the English language of the manuscript.

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Authors and Affiliations

  1. Neonatal and Pediatric Intensive Care Unit, Bordeaux Teaching Hospital, 33076, Bordeaux Cedex, France

    Olivier Brissaud & Julie Guichoux

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  1. Olivier Brissaud
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  2. Julie Guichoux
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Correspondence to Julie Guichoux.

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Brissaud, O., Guichoux, J. Patent Ductus Arteriosus in the Preterm Infant: A Survey of Clinical Practices in French Neonatal Intensive Care Units. Pediatr Cardiol 32, 607–614 (2011). https://doi.org/10.1007/s00246-011-9925-8

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  • DOI: https://doi.org/10.1007/s00246-011-9925-8

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