Current treatment in preterm infants is not always necessary

Editorial medical facts / Janine Budding December 08, 2022 – 07:25

Not treating the canal is as safe as treating it
Preterm infants whose blood vessels that supply oxygen to the body before birth do not close immediately on their own are routinely treated. Waiting for this blood vessel, the duct, to block on its own is perfectly safe, according to research coordinated by Radboud University Medical Center. There is even tentative evidence that medications that block the ducts increase the risk of chronic lung damage.
In premature babies, the ductus (or ductus botalli), the blood vessel that supplies oxygen to the fetus’s body during pregnancy, often doesn’t close on its own right away. Worldwide, these babies often receive ibuprofen after birth, so that the vessel closes. This has been the prevailing thought for years, preventing complications such as cerebral hemorrhage or chronic lung disease. But there has long been uncertainty about whether the patent channel should be addressed by administering drugs or whether a wait-and-see policy would be better. This is why the study was launched in December 2016, led by Professor of Neonatology Willem de Bode from Radebodomec. This included 273 children born at up to 28 weeks’ gestational age. In one group, the duct was closed with the help of ibuprofen, and in the other group, the duct closed on its own was waited for. The results are now published in the New England Journal of Medicine, in an article for which doctoral student Tim Hundscheid was first author. This shows that a wait-and-watch policy, in which a channel is naturally closed over time, is just as safe as a policy in which a treatment is given. The starting point was the chance that the baby would survive without serious complications in the lungs or intestines. De Boode, of the Department of Neonatology at Radboudumc Amalia Children’s Hospital: “This means a huge revolution in our thinking about the canal. Our belief is changing.
Patent ductus arteriosus with normal cardiac anatomy. Vector illustration of a congenital heart anomaly.
In this photo on the left, the heart without an open duct, on the right with an open duct.

Is the cure worse than the disease?

This is not the only result. Researchers have found evidence that ibuprofen may increase the risk of chronic lung disease. De Bode and his colleagues were surprised by this finding. We expected to show that no treatment would be as good as the treatment. But the results tentatively indicate that ibuprofen use could have serious consequences. Ibuprofen seems to be worse than the disease, the innocence channel. The complications we attribute to the patent channel are also side effects we also know from ibuprofen. “We want to find out exactly how this works while continuing research,” says the neonatologist.

According to De Boode, we cannot yet say that there is no better treatment than a cure. There is certainly a selection of treatment is necessary. We now want to know which children are involved in the treatment, and also which treatment is the best. A possible alternative to medication is an operation in which a tampon is inserted through a catheter through the groin that closes the duct.

Parent participation

Willem de Bode stresses the importance of scientific research on premature babies. “We still have a lot to learn about these babies. This is why this type of research is so important, it increases our knowledge. It is especially grateful to the parents of the babies who cooperated. Most of the parents were completely overwhelmed by the premature birth of their babies and their admission to intensive care “Within the first three days after birth, we asked them if they wanted to collaborate. I am very grateful that so many of them wanted to contribute to this research and gave us their trust. Without them we would not have gained this knowledge.”

Professor of Neonatology Willem de Bode.

Source: Radboudumc

Editorial medical facts / Janine Budding

I have specialized in interactive news for healthcare providers, so that every day healthcare providers are informed of news that may be relevant to them. Both developed news and news specifically for healthcare providers and prescribers. Social media, women’s health, patient advocacy, patient empowerment, personalized medicine and care 2.0, and the social sphere are some of the top things you should pay more attention to.

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