The use of high dose oral ibuprofen may be the best way to treat patent ductus arteriosus (PDA), and has the potential to prevent risky heart surgeries on premature babies. In a study published in the Journal of the American Medical Association, Dr. Souvik Mitra, a neonatologist at the IWK Health Centre, found that high dose ibuprofen ranked highest among medical therapies used to treat PDA, a common heart problem which occurs most often in premature infants. In the study Mitra and his team analysed data from studies published between 1980 and 2017 from 68 randomized trials which involved 4,802 preterm infants with PDA.
“People have been researching PDA in preemies for the last 40 years without a clear answer. This kind of research puts everything into perspective,” says Mitra. “What has been used as the standard of care for PDA treatment turns out to be one of the least effective.”
“What has been used as the standard of care for PDA treatment turns out to be one of the least effective.”
Before birth, the aorta and the pulmonary artery are connected by the ductus arteriosus, a blood vessel essential to fetal blood circulation. Within minutes or up to a few days after birth, the vessel should close as part of the normal changes occurring in the baby’s circulation. In some babies, especially those born premature, the ductus arteriosus remains open (patent). If the PDA is small and not interfering with blood flow then time may lead to a spontaneous closure. However, if it does not close on its own and starts affecting the baby’s circulation, drug therapy is necessary. Surgery is usually the last resort when multiple attempts at closing the PDA with drug therapy is ineffective.
“Our son Knox had surgery when he was 25 days old and weighed only 2 lbs 2 oz. When we sat down with the surgeon and discussed the complications that could arise from PDA ligation surgery she described it as being like delicate wet tissue paper that could tear very easily,” says Nick Hann. “As parents of a child who have been through the PDA ligation surgery we are thrilled with Dr Mitra’s research and findings that could eliminate the need for surgery on future NICU preemies.”
“When we sat down with the surgeon and discussed the complications that could arise from PDA ligation surgery she described it as being like delicate wet tissue paper that could tear very easily.”
PDA is a common condition in preterm infants born earlier than 33 weeks of gestation. According to the Canadian Neonatal Network Annual report 2016, 28 out of every 100 infants born before 33 weeks in Canada were diagnosed with PDA. Out of the ones diagnosed with PDA six per cent required a surgery.