by lvnurs9

Have you heard of these new studies that are apparently showing that there are no advantages in the long run to treating a PDA?? I am so used to ligating kids that are either micros or very symptomatic. At my new hospital (well 2 in this state), they are talking about not treating them anymore! I have seen more CHF in the past 8 months then in the past 4 years. How can these studies be accurate??

Are you changing your practice? Do you have any links to or information on these studies?

Thanks!

Re: New PDA Treatment Recommendations??

We treat symptomatic PDAs. We very rarely use indocin/neoprofen or ligate kids here.... we are just careful with fluids/boluses. Most of our PDA ligations are preemies transported in specifically for that.

Re: New PDA Treatment Recommendations??

So you just fluid restrict? I guess I am trying to find out how to treat them. I am not used to using meds, because Indocin is usually more harmful then good and Neoprofen never works. But, I can't figure out what they are doing wrong here that so many kids are being mismanaged and are ending up in CHF!

That is one thing they can't seem to figure out here. You can't try to "treat" a PDA and run fluids at 150/kg!

Re: New PDA Treatment Recommendations??

I would be interested to see these studies. What factors and outcomes are they considering? There are a lot of side considerations. e.g...If you have a symptomatic PDA that is slowing down your ability to extubate, you run a higher risk of VAP amongst other things.

Re: New PDA Treatment Recommendations??

Also, what if there is shunting, and the gut is not getting good blood flow? Wouldn't you be concerned about NEC? We are talking a lot about that now and how some hospitals don't start feeds until the PDA is closed. If it doesn't close on its own, how long can you wait to start feeds if you don't do something to close it?

Re: New PDA Treatment Recommendations??

We also only treat when they're symptomatic. If they're able to get Indocin, they get that, along with fluid restriction (usually at 80/kg/d). If not / if Indocin doesn't work, we'll ligate if they're still symptomatic.

Re: New PDA Treatment Recommendations??

My biggest frustration is having a very symptomatic kid who they "sit" on because "studies show" that treatment is not effective. How does this make any sense?!?!

And I'm talking 24 weeker who has always been on vapotherm (wow) being reintubated at 3wks on a rate of 50, never able to feed.... her brother on 1/2 feeds with bloody residuals... or the six month old who can't go home cause she is in CHF.... so many babies staying way too long because they are dependent on 5L NC and O2, can't nipple... the list goes on! I mean treat them and be done with it!

Re: New PDA Treatment Recommendations??

Depends on the attending...with the two trains of thought, to treat or not treat surgically, we may be sending kids out for ligations all one month and the next just using ibuprofen, which works on some kids, but as soon as they get stressed that duct just pops back open.

Re: New PDA Treatment Recommendations??

Ours is attending-dependent. A few of ours say that it is a normal finding in a premie and should not be treated; others try indocin/neoprofen a couple of courses, then ligate. It's frustrating to say the least. I have also heard one of the docs say that an open ductus does NOT cause the saturation swings/desats which we have always associated with PDA....I find that hard to believe.
So frequently the kids that they treat medically reopen and get worse. I'm a die-hard believer in ligating and "getting it over with".
I have not seen any real evidence one way or the other; it's just doctor's conflicting opinions.

Re: New PDA Treatment Recommendations??

We have a Pediatric surgeon that does our ligations..and she really, really hates doing them.

She is very non-egotistical physician and is constantly searching for a better way to do things. We are constantly having things changed (for the better) in our NICU because of things that she has found from her research.

I'm a new grad, but the senior nurses truly believes this woman walks on water.

I do know that she does not ligate unless the PDA is causing substantial problems.