Management of the PDA Trial

Purpose

Estimate the risks and benefits of active treatment versus expectant management of a symptomatic patent ductus arteriosus (sPDA) in premature infants.

Conditions

  • Infant, Premature
  • Patent Ductus Arteriosus
  • Infant, Newborn, Diseases
  • Patent Ductus Arteriosus After Premature Birth

Eligibility

Eligible Ages
Between 48 Hours and 21 Days
Eligible Genders
All
Accepts Healthy Volunteers
No

Inclusion Criteria

  • Postnatal age 48 hours -21 days - Infant 22 0/7 to 28 6/7 weeks gestation at birth - sPDA, as defined as: 1. Mild, Moderate, or Severe Clinical Criteria with Small or Moderate size PDA on echocardiogram 2. Mild or Moderate Clinical Criteria with Large PDA on echocardiogram

Exclusion Criteria

  • Cardiopulmonary compromise - Known congenital heart disease (besides atrial septal defect or ventricular septal defect) - Known pulmonary malformation (e.g. congenital lobar emphysema, congenital pulmonary adenomatous malformation) - Any condition which, in the opinion of the investigator, would preclude enrollment

Study Design

Phase
Phase 3
Study Type
Interventional
Allocation
Randomized
Intervention Model
Parallel Assignment
Primary Purpose
Treatment
Masking
None (Open Label)

Arm Groups

ArmDescriptionAssigned Intervention
Active Comparator
Active Treatment Group 		Infants assigned to the active treatment group will receive indomethacin or ibuprofen per their local site usual care dosing and schedule if the infant has a sPDA. The choice of indomethacin or ibuprofen will be left to the center, however, infants may only receive one or the other.
  • Other: Active Treatment
    Infants assigned to the active treatment group will receive indomethacin or ibuprofen per their local site usual care dosing and schedule if the infant has a sPDA. The choice of indomethacin or ibuprofen will be left to the center, however, infants may only receive one or the other. If the infant receives both, it will be considered a protocol violation.
Active Comparator
Expectant Management Group 		Infants assigned to the expectant management group will receive indomethacin or ibuprofen if cardiopulmonary compromise occurs.
  • Other: Expectant Management
    Infants assigned to the expectant management group will receive indomethacin or ibuprofen if cardiopulmonary compromise occurs.

Recruiting Locations

University of Texas Health Science Center at Houston
Houston, Texas 77030
Contact:
Jon E Tyson, MD MPH

More Details

Status
Recruiting
Sponsor
NICHD Neonatal Research Network

Study Contact

Matthew Laughon, MD, MPH
984-974-5063
matt_laughon@med.unc.edu

Detailed Description

This is a pragmatic randomized multicenter, effectiveness study comparing active treatment of a symptomatic patent ductus arteriosus (sPDA) to expectant management. We hypothesize in premature infants with a sPDA, expectant management reduces the incidence proportion of death or BPD by 10% (from 50% to 40%) when compared to active treatment. Participants with a sPDA allocated to the active treatment arm will receive intravenous administration of indomethacin or ibuprofen (depending on center preference). The decision to ligate will be left to the clinical team. Participants with a sPDA allocated to the expectant management arm will receive supportive care at the clinical team's discretion and will receive indomethacin/ibuprofen or ligation if the infant develops cardiopulmonary compromise. The decision to ligate will be left to the clinical team. The primary endpoint for the study will be death or BPD (as assessed by the physiologic definition) at 36 weeks postmenstrual age (PMA).