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Comment & Response |

Patent Ductus Arteriosus in Preterm Neonates—Concerns With Some Recommendations

Sergio G. Golombek, MD, MPH1,2,3; Augusto Sola, MD3
[+] Author Affiliations
1Division of Newborn Medicine, Department of Pediatrics and Clinical Public Health, New York Medical College, Valhalla
2Maria Fareri Children’s Hospital at Westchester Medical Center, Valhalla, New York
3SIBEN (Iberoamerican Society of Neonatology), Dana Point, California
JAMA Pediatr. 2015;169(12):1177. doi:10.1001/jamapediatrics.2015.2789.
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To the Editor We read with interest the review article by Jain and Shah.1 It is a very detailed summary of the current management of patent ductus arteriosus in preterm neonates.1 However, we are concerned with the apparent recommendation in Figure 1 for the use of diuretics and digoxin. Bhatt and Nahata2 recommended against the use of digoxin, as its risks seem to outweigh the benefits. Furthermore, Bhatt and Nahata do not include any comments regarding furosemide. In 2008, we published the first Clinical Consensus of the Iberoamerican Society of Neonatology (SIBEN),3 where 2 recognized experts in the field (Ron Clyman, MD, University of California at San Francisco, and Bart Van Overmeire, MD, Université libre de Bruxelles) and 45 neonatologists from 23 countries were invited for active participation and collaboration. We stated there that “the use of furosemide could increase the prevalence of PDA [patent ductus arteriosus] due to its effects as a prostaglandin inhibitor.”4 Furosemide increases prostaglandin production at the renal level. Therefore, the ductus response to the pharmacologic closure treatment with prostaglandin inhibitors (indomethacin and ibuprofen) could be minimized according to randomized studies. Moreover, to our knowledge, there are no studies that report significant benefits of furosemide and none documented long term. Furosemide not only increases the prevalence of ductal patency and can inhibit indomethacin efficacy for closure, but also leads to metabolic, hydroelectrolytic, and renal risks (nephrocalcinosis), as well as hypoacusia. Therefore, based on the available literature, this consensus group did not recommend the use of diuretics and even less of furosemide at this gestational and postnatal age. In 2014, we repeated these recommendations in our Neofarma SIBEN.5

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December 1, 2015
Prakesh S. Shah, MD, MSc, FRCPC; Amish Jain, MBBS, MRCPCH
1Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada2University of Toronto, Toronto, Ontario, Canada
JAMA Pediatr. 2015;169(12):1177-1178. doi:10.1001/jamapediatrics.2015.2792.
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