cardiovascular-agents and Bronchopulmonary-Dysplasia

To determine whether N-terminal-pro-brain natriuretic peptide (NT-proBNP) level could be an effective guide for early targeted indomethacin therapy for patent ductus arteriosus (PDA) in preterm infants.. An interventional study involved preterm infants, born at <33 weeks of gestation, who had plasma NT-proBNP levels obtained at day 2 of life. Indomethacin therapy was given if plasma NT-proBNP level was ≥10,180 pg/mL, the cut-off for predicting hemodynamic significant PDA (hsPDA). Echocardiograms were performed within 6 h at the time of plasma NT-proBNP collection and again at day 7, or whenever clinical hsPDA was suspected. Primary outcomes were the incidence of later hsPDA and unnecessary exposure rate to indomethacin.. Fifty infants were enrolled. On day 2, 19 (38%) infants had plasma NT-proBNP above the cut-off and received indomethacin therapy; none of them developed later hsPDA, while 1 of 31 infants with NT-proBNP below the cut-off level developed clinical hsPDA. Unnecessary exposure to indomethacin occurred in two infants (11%). Overall, no enrolled infants had either reopening of ductus or PDA ligation.. Using NT-proBNP level on day 2 as a guide for early targeted indomethacin therapy reduced later onset of hsPDA and the number of unnecessary exposures to indomethacin.

Topics: Bronchopulmonary Dysplasia; Cardiovascular Agents; Ductus Arteriosus, Patent; Female; Humans; Indomethacin; Infant; Infant, Newborn; Infant, Premature; Male; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Statistics as Topic; Time Factors

Decision Aids (DA) are well established in various fields of medicine. It can improve the quality of decision-making and reduce decisional conflict. In neonatal care, and due to scientific equipoise, neonatologists caring for extreme low birth weight (ELBW) infants are in need to elicit parents' preferences with regard to the use of indomethacin therapy in ELBW infants. We aimed to develop a DA that elicits parents' preferences with regard to indomethacin therapy in ELBW infants.. We developed a DA for the use of the indomethacin therapy in ELBW infants according to the Ottawa Decision Support Framework. The development process involved parents, neonatologists, DA developers and decision making experts. A pilot testing with healthy volunteers was conducted through an evaluation questionnaire, a knowledge scale, and a validated decisional conflict scale.. The DA is a computer-based interactive tool. In the first part, the DA provides information about patent ductus arteriosus (PDA) as a disease, the different treatment options, and the benefits and downsides of using indomethacin therapy in preterm infants. In the second part, it coaches the parent in the decision making process through clarifying values and preferences. Volunteers rated 10 out of 13 items of the DA positively and showed significant improvement on both the knowledge scale (p = 0.008) and the decisional conflict scale (p = 0.008).. We have developed a computer based DA to assess parental preferences with regard to indomethacin therapy in preterm infants. Future research will involve measurement of parental preferences to guide and augment the clinical decisions in current neonatal practice.

Topics: Adult; Bronchopulmonary Dysplasia; Cardiovascular Agents; Decision Support Techniques; Ductus Arteriosus, Patent; Female; Hemorrhage; Humans; Indomethacin; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature; Intracranial Hemorrhages; Lung Diseases; Parents; Pilot Projects; Severity of Illness Index

Topics: Bronchopulmonary Dysplasia; Cardiovascular Agents; Ductus Arteriosus, Patent; High-Frequency Ventilation; Humans; Indomethacin; Infant Welfare; Infant, Newborn; Infant, Premature; Time Factors; Treatment Outcome