Medical mgmt of PDA

[elizabells, BSN, RN]

Timothy's thread about his daughter got me thinking: do indocin and ibuprofen ever actually work? I realize I've only been at this a year and a half, but I don't think I've ever seen medical management of a PDA work out. It either doesn't close the PDA or the baby perfs (indocin) or gets a bleed (ibuprofen). I mean, obviously they must work SOMEtimes or we wouldn't use them, but it just hasn't been my experience. Maybe it just doesn't get passed on in report down the road the way a ligation does, and there are no outward signs like that lump you get with a clip.

What are everyone else's experiences with this?

[Sweeper933]

I have seen Indocin work. We have only used the Ibuprofen a handful of times, and I really don't remember if it actually worked or not. When I do see Indocin work, it seems like it's in the more stable kids who just happen to have a PDA. I find that I rarely see it work in the kids who are "on the road to being chronics". They usually end up needing to be ligated...

[Loralai]

I'm not a nurse, but had a 27 weeker who Ibuprofen worked on for his PDA. He wasn't stable by a long shot; born 760 grams, on an oscillator for 2 months, IV's in every limb and too many medications to remember, 2 PICC lines, birth defects, too many infusions to count, IVH Grade 2, etc. etc. Of course, according to the neonatologist, the Ibuprofen then gave him pulmonary hypertension. He now has a small AP collateral (L->R shunt) and mild LAE rather than PDA though.

[preemieRNkate, RN]

The babies I have seen indo work on have been older (like 26-27 weeks versus the 24 weekers). And they usually are not the real sick babies (you know, HFV, pressors, etc). They tend to be the ones that we can't quite wean the vent and then, oh yeah, he has a PDA that we'll try to close with indo. I have not used ibuprofen yet, but I hear we're going to start. Sometimes I just LOVE being a nurse in a big teaching hospital . (We have 2 new attendings, one we love and one seems to be a total nutso, as well as a new-ish fellow. Fun!)

[BittyBabyGrower, MSN, RN]

We've had moderate success with ibupofen. It seems that once the dosing is done if the kid gets stressed for what ever reason the PDA opens back up again...no theory on that, but that is what we have been seeing. It also depends on the attending on...some try ibuprofen first if indicated, others will ligate right away. We don't use indocin at all anymore and we are all glad...no more perfs! We haven't had any kids bleed from the ibuprof.

[fmrnicumom]

I'm not a nurse, but 2 rounds of indocin partially closed my son's PDA. It was enough that they decided to watch and see how he did. It ended up closing on its own after that, even though it took awhile. He was a 28 weeker and was not completely stable but not exactly unstable either. I became friends with the mom of the little girl next to him and she was a 30 weeker, IUGR, said to have a "large PDA" and the indocin closed hers. I don't know if it is relevant or not but I was given indocin (in addition to mag sulfate and terbutaline) several times in an attempt to stop labor.

Tiffany

[prmenrs, RN]

I think it's in the timing. I remember giving it almost right after birth. It went like this: birth, resus, tube, surfactant, lines, move to SIMV (non invasive vent) giraffe, plastic wrap, humidity, antibx if indicated, IV protein (given separate from maintanence IV) and vitamins, indocin/ibuprofen. All supposed to happen w/in 12 hours so they can start trophic feeds asap.

They're gonna have a duct, in all likelihood, so why wait till it's compromising things--give it right away. Seems to me you're better off giving it sooner rather than later.

I have certainly seen it work. It seemed unusual to have a kid need a ligation. As I was reading Tim's experience, I was going nuts--give the Indocin/Ibu already. What are you waiting for?

The late, occassionally great Louis Gluck used to say, "you can't ventilate a duct".

[Sweeper933]

With us, all