Potsiurko S. Clinical and instrumental substantiation of a differentiated approach to the treatment of patent ductus arteriosus in preterm infants – on the rights of the manuscript

The results of the retrospective study showed that pharmacological PDA treatment with ibuprofen and paracetamol did not differ significantly in efficacy and did not provide a better outcome compared with infants, who were managed expectantly, although the median PDA diameter in infants in the expectant management group was significantly smaller than in children receiving treatment. Systemic NT-proBNP concentrations, which can be used to predict the occurrence of hsPDA, have been established (AUC=0.93; [95 % confidence interval (CI): 0.86–1.0]; p<0.05). It was determined that serum NT-proBNP concentration ≥ 12000 pg/ml in very preterm infants with PDA diameter > 1.5 mm at the age of 2-3 days, had 100 % sensitivity and 80 % specificity for predicting the development of hsPDA. Serum NT-proBNP concentrations in very preterm infants were reliably associated with echocardiographic markers of hsPDA and were inversely proportional to the gestational age of infants. Serum NT-proBNP concentrations ≤ 23,800 pg/ml in very preterm infants with PDA diameter >1.5 mm at 2-3 days of life allowed to predict the ductus closure in the first 10 days after birth in response to specific pharmacological treatment (AUC=0.81 [95 % CI: 0.58–1.03]; p<0.05). Serum NT-proBNP levels were significantly correlated with systemic C-reactive protein (CRP) concentrations on days two (rS=0.35, p=0.01) and eight (rS=0.36, p=0.01). Serum NT-proBNP concentrations ≥ 17,745 pg/ml in very preterm infants with PDA > 1.5 mm at 2-3 days of life had 55 % sensitivity and 81 % specificity for the prediction of bronchopulmonary dysplasia (BPD) or death, and the concentrations ≥ 3537 pg/ml at 8-9 days of life – 60 % and 89 %, respectively. It was found that the efficacy and safety (renal failure, oliguria, gastrointestinal and pulmonary hemorrhage) of PDA treatment with rectal ibuprofen or intravenous paracetamol did not differ significantly. The obtained results suggest that paracetamol may be an effective and safe alternative to ibuprofen in an attempt at pharmacological ductus closure, especially if there are contraindications to the use of COX inhibitors. In particular, it has been shown that rectal administration of ibuprofen is an acceptable alternative to its intravenous use and is acceptable regardless of the condition and tolerance to enteral nutrition of the child when oral intake of the medication may not possible. The randomized study has found that early pharmacological treatment provides more frequent and faster PDA closure in preterm infants with gestational age of < 32 weeks compared with expectant management. However, it does not improve survival or reduce morbidity. Only 8 % of infants in the expectant management arm required pharmacological PDA closure according to the study protocol. In the majority of untreated infants, DA closed spontaneously, and the incidence of PDA at the time of discharge did not differ significantly depending on the management strategy (at the time of discharge, DA was closed in 83 % of infants in the treatment group and 78 % of newborns in the expectant management group; p>0.05).