What is the Purpose of this Study?
This study compares 2 methods of treating infants who were born prematurely with a patent ductus arteriosus (PDA). A PDA is a blood vessel connecting the lungs and the heart. All infants have a PDA when they are born, and most PDAs close shortly after birth. In premature infants, the PDA can stay open, which may cause breathing problems. Infants born early (more than 12 weeks before the planned delivery date) who need help breathing using a machine (ventilator) and who have an open PDA may qualify for this study. Both widely used treatment approaches in this study are considered standard of care.
Researchers aim to determine which method is most effective to treat infants with open PDAs within the first weeks of life for best possible health outcomes. Specifically, the study will compare catheter closure to responsive management. In catheter closure, the PDA will be closed with a device called Piccolo (approved by the U.S. Food and Drug Administration) that is inserted with a small flexible tube (catheter). Responsive management would manage the symptoms caused by the PDA, which may include medications and changes in fluid amounts given to the infant, allowing more time for the PDA to possibly close on its own. Participants will be randomly assigned to either the catheter closure group or the responsive management group.
Eligibility
- 1. EPIs born between 22-weeks+0 days (220/7 wks) and 27-weeks+6 days (276/7 wks) gestation, inclusive
- 2. Admitted to a study NICU
- 3. Birth weight ≥700-grams
- 4. Mechanically ventilated at time of consent and randomization
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Inclusion Criteria:
- 1. EPIs born between 22-weeks+0 days (220/7 wks) and 27-weeks+6 days (276/7 wks) gestation, inclusive
- 2. Admitted to a study NICU
- 3. Birth weight ≥700-grams
- 4. Mechanically ventilated at time of consent and randomization
- 5. HSPDA ("PDA Score" ≥6) noted on echocardiogram (ECHO)
- 6. Randomization is able to be performed within 5 days of the qualifying ECHO and when infant is 7-32 days postnatal
Exclusion Criteria:
- 1. Life-threatening congenital defects (including congenital heart disease such as aortic coarctation or pulmonary artery stenosis). PDA and small atrial/ventricular septal defects are permitted;
- 2. Congenital lung abnormalities, (e.g. restrictive lung disease);
- 3. Pharyngeal or airway anomalies (tracheal stenosis, choanal atresia);
- 4. Treatment for acute abdominal process (e.g., necrotizing enterocolitis);
- 5. Infants with planned surgery;
- 6. Active infection requiring treatment;
- 7. Chromosomal defects (e.g., Trisomy 18);
- 8. Neuromuscular disorders;
- 9. Infants whose parents have chosen to allow natural death (do not resuscitate order) or for whom limitation of intensive care treatment is being considered (e.g. severe intraventricular hemorrhage)
- 1. Pulmonary hypertension (defined by ductal right to left shunting for \>33% of the cardiac cycle) in which early PDA closure may increase right ventricular afterload and compromise pulmonary and systemic blood flow;
- 2. Evidence of cardiac thrombus that might interfere with device placement;
- 3. PDA diameter larger than 4 mm at the narrowest portion (consistent with FDA-approved instructions for Piccolo™ device use).
- 4. PDA length smaller than 3 mm (consistent with FDA-approved instructions for Piccolo™ device use).
Other Exclusion Criteria
- 1\. Parents or legal guardian do not speak English or Spanish
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Where can I participate?
Beverly
More about this Clinical Trial
What is the full name of this clinical trial?
Percutaneous Intervention Versus Observational Trial of Arterial Ductus in Low weight Infants