<i>The Cochrane Library</i> and treatment of patent ductus arteriosus: an overview of reviews
Bibliographic record
Abstract
Abstract Background Patent ductus arteriosus (PDA), the condition in which the ductus arteriosus (DA) does not close, is a common problem in preterm and low birth weight infants. It is associated with significant mortality and morbidity in these children. Objectives To critically evaluate the evidence available in the Cochrane Library regarding the treatment of PDA with ibuprofen (IBU) and indomethacin (INDO) in preterm and/or low birth weight infants. Methods The Cochrane Library was searched using the term ‘patent ductus arteriosus.’ Reviews discussing pharmacological interventions with IBU and INDO in premature infants were included. Data on clinically important outcomes were extracted by one author and independently evaluated. Primary outcomes pre‐specified for inclusion in this overview were: failure to close a PDA, reopening of the ductus arteriosus after initial closure, need for retreatment/need for surgical closure and symptomatic PDA. Main results Four reviews, containing 31 trials and 1739 participants, were included in this overview. In these reviews five unique comparisons were indentified: IBU versus placebo or no treatment, IBU versus INDO, prolonged versus short course of INDO, INDO versus placebo for asymptomatic PDA, and continuous versus bolus INDO for symptomatic PDA. Of the primary outcomes, IBU decreased need for retreatment [risk ratio (RR) 0.38, 95% confidence interval (CI) 0.19 to 0.75; risk difference (RD) − 0.22, 95% CI − 0.36 to − 0.08; number needed to treat (NNT) = 6] and INDO reduced the rate of subsequent symptomatic PDA (RR 0.36, 95% CI 0.19 to 0.60; RD − 0.36, 95% CI − 0.52 to − 0.17; NNT = 5) when each was compared to placebo. Other primary outcomes (failure to close PDA, reopening of DA after closure and need for surgical ligation) were not statistically significant in any of the reviews in which they were reported. One review compared length of INDO treatment and showed that infants receiving shorter courses of drug had fewer episodes of necrotizing enterocolitis (NEC) (RR 1.87, 95% CI 1.07 to 3.27; RD 0.08, 95% CI 0.01 to 0.15; NNT = 15). Another review addressed efficacy of continuous versus bolus dose INDO in preterm infants with a symptomatic PDA. No statistically significant differences were found between these two regimens. In a separate review IBU was compared with placebo and with INDO for treatment of PDA. Twenty trials were included in the comparison of IBU versus INDO. The two drugs showed no difference in failure to close a PDA (RR 0.94, 95% CI 0.76 to 1.17); however, use of IBU was associated with a lower risk of NEC (RR 0.68, 95% CI 0.47 to 0.99; RD, − 0.04, 95% CI − 0.08 to 0.00; NNT = 27) as compared with INDO. Authors' conclusions Although both INDO and IBU successfully close the DA, our overview found no evidence of significant difference between these two drugs for the majority of outcomes reported. If medical treatment is undertaken for closure, there is no significant difference in rate of failure to close the PDA between INDO and IBU. There is an advantage to IBU as there is less association with NEC, although the magnitude of this benefit is small. If INDO is used it should be a short course, again to decrease the risk of NEC. Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.034 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.008 |
| Bibliometrics | 0.015 | 0.019 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.011 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".