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Indian Pediatr 2016;53: 78 |
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When to Close Patent Ductus Arteriosus? —
Author’s Reply
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Nandkishor Kabra
Surya Mother and Child Care, Santacruz (W). Mumbai,
India.
Email: [email protected]
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We thank the readers for highlighting clinically
valid important points related to our trial on paracetamol in treatment
of patent ductus arteriosus (PDA) [1] in preterm infant. The high
closure rates of PDA in our study is direct reflection of adopting the
"targeted treatment" strategy. It has been shown in the past that a
ductal diameter of 1.5 mm or greater has a sensitivity of 81% and
specificity of 85% in predicting subsequent development of clinically
symptomatic PDA [2]. All three treatment strategies in treatment of PDA
in preterm neonates have one or the other drawback. In prophylactic
mode, we end up treating approximately 50% infants who are not destined
to develop significant PDA. If we adopt therapeutic approach, we treat
when infant becomes clinically symptomatic and the response to
therapeutic interventions is expected to be 50 to 80% with risk of
reopening in some cases. While adopting targeted therapy, we are
doing the balancing act between the prophylactic and therapeutic
strategies. We, however; may be over-treating approximately 20% cases
not destined to develop symptomatic PDA later [2]
We believe that closing an echocardiographically
proven significant PDA only when the child develops complications may be
too late!
References
1. Dash SK, Kabra NS, Avasthi BS, Sharma SR, Padhi P,
Ahmed J. Enteral paracetamol or intravenous indomethacin for closure of
patent ductus arteriosus in preterm neonates: A randomized controlled
trial. Indian Pediatr. 2015; 52:573-8.
2. Kluckow M, Evans N. Early echocardiographic
prediction of symptomatic patent ductus arteriosus in preterm infants
undergoing mechanical ventilation. J Pediatr. 1995;127:774-9.
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