a randomised controlled trial of early targeted Patient Ductus Arteriosus treatment using a risk-based severity score
Principal Investigator – Prof. Afif El-Khuffash
A patent ductus arteriosus (PDA) is a blood vessel connecting the two major vessels leaving the heart: the aorta and the pulmonary artery (see picture below). While the baby is in the womb, it works as a lung bypass, sending blood away from the lungs to the rest of the body. In babies born at full term this connection usually closes in the first few days. In most babies born less than 29 weeks gestation the PDA can remain open for a long time. If this occurs, the PDA actually sends blood towards the lungs and away from the rest of the body (in a way opposite to that in the womb). This could cause the lungs to receive extra fluid and become water-logged. A PDA can be diagnosed in preterm babies using an ultrasound test of the heart called an echocardiogram.
Premature babies can have some problems relating to early birth. Those include a condition called “Chronic Lung Disease”, or “CLD” for short. This is a condition affecting the growth of the lungs. This condition can result in your baby needing oxygen for a long period of time during his/her stay in the hospital and sometime even for a few months after discharge from the hospital. Babies who are premature who also have a large PDA have a higher chance of having CLD. But we are not sure if a PDA causes CLD or whether the two conditions happen together in a premature baby.
A PDA can be closed in a preterm baby over the first 48 hours of age using a medication called Ibuprofen. This is the same medication that you may have used for headaches (Neurofen). Ibuprofen has been used to close PDAs in preterm babies for many years and has been shown to be a safe way of closing the PDAs without needing surgery. However, using Ibuprofen to close PDAs in all premature babies does not reduce the chance of them developing CLD. As a result, many hospitals that care for preterm babies do not close the PDA in preterm infants in the first few days of age. Those hospitals watch the open PDA and wait for it to either close naturally by its own during the baby’s hospital stay (the commonest outcome) or refer the baby for closure by a specialist heart surgeon (a rare outcome). Both approaches to PDA treatment (either using Ibuprofen to close it early or waiting for the PDA to close on its own) are accepted ways to care of your baby as there is no difference to the chance of developing CLD in either way of management.
We however, think that certain babies with a larger PDA and low heart function may actually benefit from closing their PDA using Ibuprofen in the first 48 hours of age. We have developed a way of accurately predicting which baby with a PDA will go on to develop CLD using echocardiography. We would like to see if closing the PDA early in this situation results in a lower chance of developing CLD.