IWK approach to treating preterm infants with PDA being studied across North America

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IWK Health is reporting the first use of high dose ibuprofen in North America to treat patent ductus arteriosus (PDA) a common heart problem which occurs most often in extremely premature infants. In a paper published in the Journal of Perinatology the treatment shows a 21 per cent reduction in the need for the risky heart surgery.

The use of high dose ibuprofen as the preferred way to treat PDA was first reported in 2018 by Dr. Souvik Mitra, a neonatologist at IWK Health. The study published in the Journal of the American Medical Association has since led to many other Canadian health centres adopting a similar approach.

“We are really happy to find that our approach of using high-dose ibuprofen is making a difference locally here at the IWK,” says Mitra. “We’ll only know if it benefits preterm babies regardless of the clinical setting if we find similar results in our ongoing multicentre comparative effectiveness study that covers majority of the Canadian neonatal intensive care units (NICU).”

Dr. Souvik Mitra, photo by Gabrielle Gallant, IWK Health

Mitra is currently leading a study funded by the Canadian Institutes of Health Research (CIHR) across 22 Neonatal Intensive Care Units across Canada to compare PDA treatments across the country. He was also recently awarded the CIHR Early Career Investigators in Maternal, Reproductive, Child and Youth Health Operating grant to conduct the first ever randomized controlled trial exclusively on premature babies born less than 26 weeks of gestation to find out if selective early treatment of the PDA helps to improve their outcomes. Four more centres in Canada and two in the United States have signed up to join this study.

“One unresolved issue that may affect treatment response in the tiniest of babies is timing of treatment,” says Mitra. “This upcoming research (SMART-PDA trial) is exciting as it hopefully will help us target the right group of babies and treat them early and effectively without unnecessarily exposing other extremely preterm babies to these medications. This might save them from a potential heart surgery.”

Mitra recently authored the first ever position statement on the management of PDA in preterm infants for the Canadian Pediatric Society. The statement is currently in press, awaiting publication.

PDA is a common condition in preterm infants born earlier than 33 weeks of gestation, especially problematic in babies born extremely premature (born less than 28 weeks of gestation). 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.

According to the Canadian Neonatal Network Annual report 2019, 56 out of every 100 infants born before 28 weeks in Canada were diagnosed with PDA. Out of the ones diagnosed with PDA seven per cent required a heart surgery.