A decision aid for considering indomethacin prophylaxis vs. symptomatic treatment of PDA for extreme low birth weight infants

We developed a DA for the use of the indomethacin therapy in ELBW infants according to the Ottawa Decision Support Framework. The development process involved parents, neonatologists, DA developers and decision making experts. A pilot testing with healthy volunteers was conducted through an evaluation questionnaire, a knowledge scale, and a validated decisional conflict scale.The DA is a computer-based interactive tool. In the first part, the DA provides information about patent ductus arteriosus (PDA) as a disease, the different treatment options, and the benefits and downsides of using indomethacin therapy in preterm infants. In the second part, it coaches the parent in the decision making process through clarifying values and preferences. Volunteers rated 10 out of 13 items of the DA positively and showed significant improvement on both the knowledge scale (p = 0.008) and the decisional conflict scale (p = 0.008).We have developed a computer based DA to assess parental preferences with regard to indomethacin therapy in preterm infants. Future research will involve measurement of parental preferences to guide and augment the clinical decisions in current neonatal practice.Due to its high rate of mortality and morbidity, prematurity is by far the most important issue in modern perinatal medicine. Patent ductus arteriosus (PDA) is very common among very low birth weight infants (VLBW), the delay in closure of the ductus is inversely related to gestational age varying from 20% in premature infants greater than 32 weeks up to 60% in extreme low birth weight infants (ELBW < 1000 g) [1,2]. PDA results in a significant left to right shunt with an increase in left ventricular output. Although it usually closes spontaneously by 5 days of age in most infants > 30 weeks' gestation, it remains patent by 5 days of age in more than two thirds of infants < 30 weeks [3].Although controversial, observational data confirmed an association of PDA with the subsequent development of b