PDA therapy. The second course?

[Darya]

Hello, colleagues!
I have a question about therapy of PDA. We are not very experienced in drug therapy for PDA. Sometimes we can use ibu for it. And I wonder: if after the first course the duct remains open, but not significant (for ex. less than 1 mm, no murmur, no clinic), should we continue a therapy (the second course) or not?
Thank you

[Stefan Johansson]

We would treat conservately if the duct has responded partially and the shunt is definitely non-significant. I would advice that you repeat the echo from after a few days and then as needed, to make sure the duct does not re-open.

It is not uncommon that medical treatment result in functional closure but you can still see a small restrictive shunt with colour doppler. Although some factors make such ducts prone to re-open (especially the situation extreme prematurity+septicemia), they commonly close anatomically with time. But it is good to know they do (echo!)

[bizzarro]

Hello Stefan,
what do you think about the new schedule of ibuprofen (irrespective of gestational age)in PDA proposed by Overmeire?
10-5-5 for newborn younger than 70 h,
14-7-7 for newborn between 70 and 108 h
18-9-9 between 108 and 180 h
Have you ever treated your patients with those doses?
Maria Antonietta Marcialis
MD NICU Cagliari
Italy

[bizzarro]

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