we conduct research rios is one of the most controversial topics in the any topology

current management of the pda usually involves really close your therapies like in a methods

and or surgical location

however recent literature reviews note that there is inadequate evidence that really aggressive pda treatment

can for any long term health benefit to premature infants

hello i'm not to joke alf in unit l adjusting clinical research or prominence segments

medical centre in portland oregon

our group conducted a before after observational trial during which we changed our pde therapy

from the traditional really closure treatment typical mostly cues to a less aggressive permissive strategy

that included number one emphasis on able see that the respiratory support number two modest

foot restriction

and number three restricted used in the madison to just those instance with large pdas

requiring persistent nasal see that or mechanical ventilation

there were no other major changes in clinical care during this study are permissive pde

therapy

included one hundred twenty nine very low birth weight infants with the pda

average gestational age twenty seven weeks at birth

mean birth weight about nine or and fifty grams compared to some highly matched previous

here a very low birth weight infants are new approach to pca management resulted in

you know methods in use declining from seventy nine percent to twenty six percent of

the infants and what was given of started later date thirteen of life rather than

data for and fewer doses were administered

and the surgical location rate declined modestly

for instance were discharged one with it still patient data structure e os is but

the majority of these clothes spontaneously is applications

there were no significant difference isn't respiratory support needs in either error except for the

greater use of nasal see that in the permissive pda time period

so comparing traditional aggressive pda therapy

clinical outcomes with our new permissive approach we found the following no significant differences and

mortality in a ventricular hemorrhage very ventricular correlation but not the prematurely knackered rising and

are quite is no the common one faction or and ice you like to stay

however

we did no significant increase in the permissive pda air in the chronic lyme disease

rate and the combined outcome of mortality a chronic disease we conclude that is biologically

plausible that prolonged exposure to a significant pda could lead to more chronic one disease

and based upon our results we modified or p d approach to a multi variable

staging assessment of the pda emphasising careful serial physical exams assessment of clinical parameters such

as respiratory support needs and specific echo correlogram findings we detail this in an explanatory

table on the manuscript

we're now closely tracking or error three visuals to see a for pragmatic approach to

pdas can minimize unnecessary treatments and i have to jenny commands or recognizing no significant

pdas require close to help avoid morbidity psychological indices

clearly randomised controlled trial is needed to define the optimal timing and choice of pda

therapies

we believe are carefully documented observational quality improvement work the largest published experience today describing

permissive pdas chirpy as important findings of interest in unit power just we believe you'll

enjoy reading about our investigation thank you