0:00:00we conduct research rios is one of the most controversial topics in the any topology
0:00:04current management of the pda usually involves really close your therapies like in a methods
0:00:09and or surgical location
0:00:11however recent literature reviews note that there is inadequate evidence that really aggressive pda treatment
0:00:16can for any long term health benefit to premature infants
0:00:20hello i'm not to joke alf in unit l adjusting clinical research or prominence segments
0:00:25medical centre in portland oregon
0:00:27our group conducted a before after observational trial during which we changed our pde therapy
0:00:32from the traditional really closure treatment typical mostly cues to a less aggressive permissive strategy
0:00:39that included number one emphasis on able see that the respiratory support number two modest
0:00:45foot restriction
0:00:46and number three restricted used in the madison to just those instance with large pdas
0:00:51requiring persistent nasal see that or mechanical ventilation
0:00:55there were no other major changes in clinical care during this study are permissive pde
0:01:00therapy
0:01:02included one hundred twenty nine very low birth weight infants with the pda
0:01:06average gestational age twenty seven weeks at birth
0:01:09mean birth weight about nine or and fifty grams compared to some highly matched previous
0:01:14here a very low birth weight infants are new approach to pca management resulted in
0:01:18you know methods in use declining from seventy nine percent to twenty six percent of
0:01:23the infants and what was given of started later date thirteen of life rather than
0:01:27data for and fewer doses were administered
0:01:30and the surgical location rate declined modestly
0:01:33for instance were discharged one with it still patient data structure e os is but
0:01:37the majority of these clothes spontaneously is applications
0:01:41there were no significant difference isn't respiratory support needs in either error except for the
0:01:45greater use of nasal see that in the permissive pda time period
0:01:50so comparing traditional aggressive pda therapy
0:01:54clinical outcomes with our new permissive approach we found the following no significant differences and
0:01:59mortality in a ventricular hemorrhage very ventricular correlation but not the prematurely knackered rising and
0:02:05are quite is no the common one faction or and ice you like to stay
0:02:09however
0:02:10we did no significant increase in the permissive pda air in the chronic lyme disease
0:02:14rate and the combined outcome of mortality a chronic disease we conclude that is biologically
0:02:21plausible that prolonged exposure to a significant pda could lead to more chronic one disease
0:02:26and based upon our results we modified or p d approach to a multi variable
0:02:30staging assessment of the pda emphasising careful serial physical exams assessment of clinical parameters such
0:02:37as respiratory support needs and specific echo correlogram findings we detail this in an explanatory
0:02:43table on the manuscript
0:02:45we're now closely tracking or error three visuals to see a for pragmatic approach to
0:02:49pdas can minimize unnecessary treatments and i have to jenny commands or recognizing no significant
0:02:54pdas require close to help avoid morbidity psychological indices
0:02:59clearly randomised controlled trial is needed to define the optimal timing and choice of pda
0:03:04therapies
0:03:05we believe are carefully documented observational quality improvement work the largest published experience today describing
0:03:12permissive pdas chirpy as important findings of interest in unit power just we believe you'll
0:03:17enjoy reading about our investigation thank you