203 - Combination therapy for Patent Ductus Arteriosus: Effectiveness and Echocardiographic Changes

Poster Number: 203
Publication Number: 203.220

Ayman Saker, Children's Hospital of Eastern Ontario, CHEO, Ottawa, ON, Canada; Aimann Surak, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada; Susan Kimani, Kenyatta National Hospital, Nairobi, Nairobi Area, Kenya; Michael R. Miller, The University of Western Ontario - Schulich School of Medicine & Dentistry, London, ON, Canada; Andrea C. De La Hoz, The University of Western Ontario - Schulich School of Medicine & Dentistry, London, ON, Canada; Renjini Lalitha, The University of Western Ontario - Schulich School of Medicine & Dentistry, London, ON, Canada; Soume Bhattacharya, The University of Western Ontario - Schulich School of Medicine & Dentistry, London, ON, Canada

Background: Combination of ibuprofen and acetaminophen is being explored for treatment of Patent Ductus Arteriosus (PDA) with speculations that this approach maybe better than traditional single agent therapy.

Objective: The objectives of the present study were to analyze the echocardiographic parameters before and after the combination therapy and to describe its use, effectiveness and adverse effects.

Design/Methods: This was a retrospective cohort study of preterm infants born < 33 weeks gestation, who were admitted to a tertiary-level neonatal intensive care unit between January 1, 2012 and December 31, 2020. Included infants received combination pharmacotherapy for PDA closure, whether as a primary course (first line use) or as a rescue (2nd/3rd course). Baseline characteristics, echocardiographic parameters of PDA hemodynamics before and after combination therapy, effectiveness of treatment, adverse effects, neonatal mortality, and morbidities rates were analyzed for any combination therapy, as well as for primary and rescue course.

Results: Thirty two infants received combination therapy during the study period; 17 infants (53%) received combination therapy as a primary course, while 16 infants (47%) received the combination therapy as a rescue course after attempting another pharmacological agent. Complete echocardiographic data were available for 17 infants who were included in the analysis (11 primary and 6 rescue).
There was an overall success rate of 41% with the use of combination therapy. Treatment success was higher for primary course compared to rescue course (55% VS 17%, respectively). The primary course group had significant reductions in ductal diameter (p=0.013), ductal flow Doppler velocities (p=0.037), restriction pattern (p=0.005) and PDA score (p=0.016) compared to the rescue group. There was no increased incidence of side effects including hepatotoxicity, thrombocytopenia, renal impairment, or gastrointestinal bleeding. However, 3 cases of intestinal perforation were noted in the combination group.Conclusion(s):: Primary combination therapy with ibuprofen and acetaminophen showed significant improvement in echocardiographic parameters of hemodynamic significance of PDA. Future trials exploring safety and effectiveness as first line treatment are needed.
combination therapy of PDA study cohort
Patients characteristics in the combination therapy of PDA studyTABLE 1, PATIENTS CHARECTERISTICS