Conservative Management of Patent Ductus Arteriosus in Preterm Infants—A Systematic Review and Meta-Analyses Assessing Differences in Outcome Measures Between Randomized Controlled Trials and Cohort Studies
Objective: This study aims to evaluate outcome after conservative management (no pharmacological/surgical intervention other than fluid restriction, diuretics, or ventilator adjustments) compared with active (pharmacological and/or surgical) treatment for patent ductus arteriosus (PDA) in preterm in...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-02-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2021.626261/full |
| _version_ | 1818857196929155072 |
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| author | Tim Hundscheid Esther J. S. Jansen Wes Onland Elisabeth M. W. Kooi Peter Andriessen Peter Andriessen Willem P. de Boode |
| author_facet | Tim Hundscheid Esther J. S. Jansen Wes Onland Elisabeth M. W. Kooi Peter Andriessen Peter Andriessen Willem P. de Boode |
| author_sort | Tim Hundscheid |
| collection | DOAJ |
| description | Objective: This study aims to evaluate outcome after conservative management (no pharmacological/surgical intervention other than fluid restriction, diuretics, or ventilator adjustments) compared with active (pharmacological and/or surgical) treatment for patent ductus arteriosus (PDA) in preterm infants and analyze differences in outcome between randomized controlled trials (RCTs) and cohort studies.Study Design: This is a systematic literature review using PubMed, EMBASE, and Cochrane library. RCTs and cohort studies comparing conservative management with active treatment were included. Meta-analysis was used to compare conservative management with any active (pharmacological and/or surgical), any pharmacological (non-prophylactic and prophylactic), and/or surgical treatment for mortality as primary and major neonatal morbidity as secondary outcome measure. Fixed-effect analysis was used, unless heterogeneity (I2) was >50%. Outcome is presented as relative risk (RR) with 95% confidence interval.Results: Twelve cohort studies and four RCTs were included, encompassing 41,804 and 720 patients, respectively. In cohort studies, conservative management for PDA was associated with a significantly higher risk for mortality (RR, 1.34 [1.12–1.62]) but a significantly lower risk for bronchopulmonary dysplasia (RR, 0.55 [0.46–0.65]), necrotizing enterocolitis (RR, 0.85 [0.77–0.93]), intraventricular hemorrhage (RR, 0.88 [0.83–0.95]), and retinopathy of prematurity (RR, 0.47 [0.28–0.79]) compared with any active PDA treatment. Meta-analysis of the RCTs revealed no significant differences in outcome between conservative management and active treatment.Conclusion: No differences in mortality or morbidity for conservative management compared with active treatment regimens were observed in RCTs. Findings from cohort studies mainly highlight the lack of high-quality evidence for conservative management for PDA in preterm infants. |
| first_indexed | 2024-12-19T08:36:33Z |
| format | Article |
| id | doaj.art-6be37e5d7b4c4688a51da805720fffce |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-12-19T08:36:33Z |
| publishDate | 2021-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-6be37e5d7b4c4688a51da805720fffce2022-12-21T20:29:01ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602021-02-01910.3389/fped.2021.626261626261Conservative Management of Patent Ductus Arteriosus in Preterm Infants—A Systematic Review and Meta-Analyses Assessing Differences in Outcome Measures Between Randomized Controlled Trials and Cohort StudiesTim Hundscheid0Esther J. S. Jansen1Wes Onland2Elisabeth M. W. Kooi3Peter Andriessen4Peter Andriessen5Willem P. de Boode6Division of Neonatology, Department of Paediatrics, Radboud Institute for Health Sciences, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, NetherlandsDivision of Neonatology, Department of Paediatrics, Radboud Institute for Health Sciences, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, NetherlandsDepartment of Neonatology, Amsterdam University Medical Centers, VU University Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, NetherlandsDivision of Neonatology, University Medical Center Groningen, Beatrix Children's Hospital, University of Groningen, Groningen, NetherlandsDepartment of Neonatology, Máxima Medical Center Veldhoven, Eindhoven, NetherlandsDepartment of Applied Physics, School of Medical Physics and Engineering, Eindhoven University of Technology, Eindhoven, NetherlandsDivision of Neonatology, Department of Paediatrics, Radboud Institute for Health Sciences, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, NetherlandsObjective: This study aims to evaluate outcome after conservative management (no pharmacological/surgical intervention other than fluid restriction, diuretics, or ventilator adjustments) compared with active (pharmacological and/or surgical) treatment for patent ductus arteriosus (PDA) in preterm infants and analyze differences in outcome between randomized controlled trials (RCTs) and cohort studies.Study Design: This is a systematic literature review using PubMed, EMBASE, and Cochrane library. RCTs and cohort studies comparing conservative management with active treatment were included. Meta-analysis was used to compare conservative management with any active (pharmacological and/or surgical), any pharmacological (non-prophylactic and prophylactic), and/or surgical treatment for mortality as primary and major neonatal morbidity as secondary outcome measure. Fixed-effect analysis was used, unless heterogeneity (I2) was >50%. Outcome is presented as relative risk (RR) with 95% confidence interval.Results: Twelve cohort studies and four RCTs were included, encompassing 41,804 and 720 patients, respectively. In cohort studies, conservative management for PDA was associated with a significantly higher risk for mortality (RR, 1.34 [1.12–1.62]) but a significantly lower risk for bronchopulmonary dysplasia (RR, 0.55 [0.46–0.65]), necrotizing enterocolitis (RR, 0.85 [0.77–0.93]), intraventricular hemorrhage (RR, 0.88 [0.83–0.95]), and retinopathy of prematurity (RR, 0.47 [0.28–0.79]) compared with any active PDA treatment. Meta-analysis of the RCTs revealed no significant differences in outcome between conservative management and active treatment.Conclusion: No differences in mortality or morbidity for conservative management compared with active treatment regimens were observed in RCTs. Findings from cohort studies mainly highlight the lack of high-quality evidence for conservative management for PDA in preterm infants.https://www.frontiersin.org/articles/10.3389/fped.2021.626261/fullPDAibuprofenindomethacinparacetamolligationplacebo |
| spellingShingle | Tim Hundscheid Esther J. S. Jansen Wes Onland Elisabeth M. W. Kooi Peter Andriessen Peter Andriessen Willem P. de Boode Conservative Management of Patent Ductus Arteriosus in Preterm Infants—A Systematic Review and Meta-Analyses Assessing Differences in Outcome Measures Between Randomized Controlled Trials and Cohort Studies Frontiers in Pediatrics PDA ibuprofen indomethacin paracetamol ligation placebo |
| title | Conservative Management of Patent Ductus Arteriosus in Preterm Infants—A Systematic Review and Meta-Analyses Assessing Differences in Outcome Measures Between Randomized Controlled Trials and Cohort Studies |
| title_full | Conservative Management of Patent Ductus Arteriosus in Preterm Infants—A Systematic Review and Meta-Analyses Assessing Differences in Outcome Measures Between Randomized Controlled Trials and Cohort Studies |
| title_fullStr | Conservative Management of Patent Ductus Arteriosus in Preterm Infants—A Systematic Review and Meta-Analyses Assessing Differences in Outcome Measures Between Randomized Controlled Trials and Cohort Studies |
| title_full_unstemmed | Conservative Management of Patent Ductus Arteriosus in Preterm Infants—A Systematic Review and Meta-Analyses Assessing Differences in Outcome Measures Between Randomized Controlled Trials and Cohort Studies |
| title_short | Conservative Management of Patent Ductus Arteriosus in Preterm Infants—A Systematic Review and Meta-Analyses Assessing Differences in Outcome Measures Between Randomized Controlled Trials and Cohort Studies |
| title_sort | conservative management of patent ductus arteriosus in preterm infants a systematic review and meta analyses assessing differences in outcome measures between randomized controlled trials and cohort studies |
| topic | PDA ibuprofen indomethacin paracetamol ligation placebo |
| url | https://www.frontiersin.org/articles/10.3389/fped.2021.626261/full |
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