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06 Dec 2018
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NSAIDs do not improve mortality in preterm infants with patent ductus arteriosus

Audrey Abella
31 Jan 2017

Nonsteroidal anti-inflammatory drug (NSAID) treatment for patent ductus arteriosus (PDA) in preterm infants did not reduce the odds of mortality or bronchopulmonary dysplasia (BPD), a recent US study found.

Instrumental variable analysis did not reveal any association between NSAID treatment and the odds of mortality or BPD (odds ratio [OR], 0.94, 95 percent CI, 0.70–1.25; p=0.69), mortality (OR, 0.73, 95 percent CI, 0.43–1.13; p=0.18), or BPD (OR, 1.01, 95 percent CI, 0.73–1.45; p=0.94). [JAMA Pediatr 2017;doi:10.1001/jamapediatrics.2016.4354]

Researchers gathered data on 12,018 infants born at 28 gestational weeks or younger from the PHIS* database (Children’s Hospital Association, Shawnee Mission, Kansas, US).

Of these, 32 percent received NSAID treatment for PDA (7 percent on ibuprofen, 27 percent on indomethacin). The infants either received an initial dose of ibuprofen or indomethacin within the initial 28 postnatal days (4 or more days). Infants who received a prophylactic indomethacin dose to prevent intraventricular haemorrhage (daily dose from birth date for 3 consecutive days) were also qualified. Infants who received NSAID doses beyond 28 postnatal days were excluded.

PDA is present in infants at birth between 25 and 28 weeks gestation and is predominant in extremely preterm infants, with 35 percent closing within 1 week. However, nonclosure is associated with increased mortality and worsened respiratory outcomes including BPD. [Semin Perinatol 2012;36:123-129; Pediatrics 2009;123:e138-e144]

Although previous studies have demonstrated the efficacy of NSAIDs in PDA treatment, their ability to improve mortality or prevent BPD remain unclear. [Cochrane Database Syst Rev (2): CD003745, 2003; Cochrane Database Syst Rev (2):CD003481, 2015; Arch Dis Child Fetal Neonatal Ed 2007;92:F498-F502]

“Our findings … support a conservative approach to PDA management … Although NSAID treatment of all infants with PDA does not appear beneficial, our findings do not imply that some infants with certain risk factors may not benefit from PDA closure,” said the researchers.

 

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Most Read Articles
06 Dec 2018
A strong belief in the necessity of medication is associated with better adherence to oral disease-modifying antirheumatic drugs (DMARDs) or prednisone, while higher self-efficacy correlates with poor adherence, in a diverse cohort of patients with rheumatoid arthritis (RA), suggests a study.
Pearl Toh, 23 hours ago
First-line therapy with the BTK* inhibitor ibrutinib plus the anti-CD20 immunotherapy rituximab confers significant survival advantage over the current gold-standard regimen of fludarabine, cyclophosphamide, and rituximab (FCR) for young, fit patients with treatment-naïve chronic lymphocytic leukaemia (CLL), according to the E1912 trial, a large cooperative group study supported by the US National Cancer Institute.
6 days ago
Low-dose administrations of haloperidol after thoracic surgery does not appear to prevent postoperative delirium, according to a new study.
4 days ago
Percutaneous coronary intervention (PCI) displays comparable rates of mortality and serious composite outcomes but a higher rate of target-vessel revascularization at 10 years relative to coronary artery bypass grafting (CABG) in patients with significant left main coronary artery (LMCA) disease, reports a study. On the other hand, CABG delivers lower mortality and serious composite outcome rates compared with PCI with drug-eluting stents after 5 years.