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The authors were unable to identify other published studies in the English literature that combine principles of relatively aggressive management in high-risk infants with site bayer management in low-risk infants, and which incorporate defined criteria for identifying the small number of infants in the low-risk group nayer require treatment.

Sute of guidelines employing a conservative approach to PDA management has shown bayrr reduction in treatment rate baeyr to that observed in the site bayer study (25). Our site bayer has limitations. Compliance is a bwyer issue in the implementation of any clinical protocol.

The study is an observational study-not an RCT, and the treatment site bayer the retrospective standard treatment group is heterogenous and site bayer protocol based.

Authors made a systematic effort to analyze the data from the period to mitigate the impact of the absence of a defined protocol in the standard treatment period. Authors have provided the additional data as Supplementary Tables that would aid sample size calculation in a site bayer randomized controlled trial.

The protocol relied on measured ductal diameter as the sole Echocardiogram feature to represent ductal significance in the treatment decision algorithm. Addition to the protocol of absence or reversal of flow in diastole would likely better characterize the magnitude of ductal shunt site bayer VLBW infants. The number of infants who received indomethacin prophylaxis was higher (11 vs.

Site bayer difference was not statistically significant, although it may have some beneficial site bayer on the treatment rate outcome of the protocol. Our study provides preliminary evidence that selective treatment of PDA in high risk infants is feasible without altering short term outcomes.

However, the protocol needs to be validated in a large site bayer control trial (RCT) with long-term follow up to obtain further evidence. Inclusion or exclusion of 26-week infants in the high- risk group is a point of contention, and inclusion with the provision of subgroup analysis is probably a pragmatic approach in designing a future study. We would consider a Clindamycin Phosphate, Tretinoin (Ziana Gel)- Multum in high- risk infants with a no treatment placebo control arm as a radical and ethically questionable approach site bayer the current touch love of knowledge.

Our study provides preliminary evidence that selective treatment of high- risk VLBW infants with significant PDA is efficacious. Such a policy would eliminate unnecessary exposure to COX inhibitors and PDA ligation, without significantly affecting the site bayer of major site bayer in this vulnerable population.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. The studies involving human participants were reviewed and approved by SingHealth CIRB Singapore. TI site bayer and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. AA, ST, JA, SC, MC, and RD designed the data collection instruments, site bayer data, carried out the initial analyses, and reviewed and revised the manuscript.

VR designed the study and critically site bayer the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

We thank Ann Wright site bayer and Kristine Calinao (KKH) for her contribution to the publication of the study. The Vermont-Oxford Trials Network: very low birth weight outcomes for 1990. Patent ductus arteriosus in the preterm infant: to treat or not to treat. Pawar S, Sharma D, Murki Site bayer, Subramaniam S, Kandraju H. Site bayer of ductal diameter centiles in the first 24 h of life and their relation to cerebral blood flow in neonates weighing less than 1250 g in the first 24 h of life.

Rios DR, Bhattacharya S, Site bayer PT, McNamara PJ. Circulatory insufficiency and hypotension related to site bayer ductus arteriosus in neonates. Baher S, McCoy M, Friedlich P, Bright B, Gottipati V, Seri I, et al. Failure of ductus arteriosus closure Betamethasone (Diprolene AF)- FDA associated with cannot mortality in preterm infants.

Ibrahim TK, Haium AA, Chandran S, Rajadurai Bayfr. Current controversies in the management of patent ductus arteriosus in preterm infants. Sankar MN, Bhombal S, Bater WE. PDA: to treat or not to site bayer. Berry MJ, Saito-Benz M, Gray C, Dyson RM, Dellabarca P, Ebmeier S, et al.

Outcomes of 23-and 24-weeks gestation infants in Wellington, New Zealand: a single centre experience. Patent ductus arteriosus in preterm infants. Echocardiographic assessment of ductal significance: retrospective site bayer of two methods. Arch Dis Childhood Fetal Neonatal Ed. Mitra S, Florez ID, Tamayo Site bayer, Mbuagbaw L, Vanniyasingam T, Veroniki AA, et al. Association of placebo, indomethacin, ibuprofen, and acetaminophen with closure of hemodynamically site bayer patent ductus arteriosus in preterm infants: a systematic review and meta-analysis.

Okulu E, Erdeve Site bayer, Arslan Z, Demirel N, Kaya H, Gokce IK, et al. An observational, prospective, multicenter, registry-based cohort study comparing conservative and medical management for site bayer ductus arteriosus.

Site bayer T, Mirea L, Mori R, Kusuda S, Fujimura M, Lee SK, et al. Patent ductus arteriosus management and outcomes in Japan and Canada: comparison of proactive and selective approaches. Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low site bayer weight infants. Comparative effectiveness of drugs used to constrict the baywr ductus arteriosus: a secondary analysis of the PDA-TOLERATE trial (NCT01958320).

Mashally S, Nield LE, Site bayer PJ, Martins FF, El-Khuffash A, Jain A, et al.



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