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IntroductionPatent ductus arteriosus (PDA) is the most common cardiovascular problem that develops in preterm infants and evidence regarding the best treatment approach is lacking. Currently available medical options to treat a PDA include indomethacin, ibuprofen or acetaminophen. Wide variation exists in PDA treatment practices across Canada. In view of this large practice variation across Canadian neonatal intensive care units (NICUs), we plan to conduct a comparative effectiveness study of the different pharmacotherapeutic agents used to treat the PDA in preterm infants.Methods and analysisA multicentre prospective observational comparative-effectiveness research study of extremely preterm infants born Standard dose ibuprofen (10 mg/kg followed by two doses of 5 mg/kg at 24 hours intervals) irrespective of postnatal age (oral/intravenous).Adjustable dose ibuprofen (oral/intravenous) (10 mg/kg followed by two doses of 5 mg/kg at 24 hours intervals if treated within the first 7 days after birth. Higher doses of ibuprofen up to 20 mg/kg followed by two doses of 10 mg/kg at 24 hours intervals if treated after the postnatal age cut-off for lower dose as per the local centre policy).Acetaminophen (oral/intravenous) (15 mg/kg every 6 hours) for 3–7 days.Intravenous indomethacin (0.1–0.3 mg/kg intravenous every 12–24 hours for a total of three doses).OutcomesThe primary outcome is failure of primary pharmacotherapy (defined as need for further medical and/or surgical/interventional treatment following an initial course of pharmacotherapy). The secondary outcomes include components of the primary outcome as well as clinical outcomes related to response to treatment or adverse effects of treatment.Sites and sample sizeThe study will be conducted in 22 NICUs across Canada with an anticipated enrollment of 1350 extremely preterm infants over 3 years.AnalysisTo examine the relative effectiveness of the four treatment strategies, the primary outcome will be compared pairwise between the treatment groups using χ2 test. Secondary outcomes will be compared pairwise between the treatment groups using χ2 test, Student’s t-test or Wilcoxon rank sum test as appropriate. To further examine differences in the primary and secondary outcomes between the four groups, multiple logistic or linear regression models will be applied for each outcome on the treatment groups, adjusted for potential confounders using generalised estimating equations to account for within-unit-clustering. As a sensitivity analysis, the difference in the primary and secondary outcomes between the treatment groups will also be examined using propensity score method with inverse probability weighting approach.Ethics and disseminationThe study has been approved by the IWK Research Ethics Board (#1025627) as well as the respective institutional review boards of the participating centres.Trial registration numberNCT04347720.

To compare selected parameters of renal circulation between small for gestational age (SGA) and appropriate for gestational age (AGA) newborns.Fifty-two SGA and 100 AGA term newborns were examined. The size of the kidneys were measured, and renal blood flow in the central and intraparenchymal renal arteries were assessed via Doppler sonography. Peak systolic velocity (PSV), end diastolic velocity (EDV), mean blood flow velocity (V mean), resistance index (RI), and pulsatility index (PI) were determined and compared between the groups.No statistically significant differences in the velocity parameters were found between SGA and AGA infants in central renal arteries. Slightly higher RIs and PIs were seen in AGA newborns (RI, 0.76 +/- 0.13 versus 0.78 +/- 0.06 [p0.05]; PI, 1.65 +/- 0.54 versus 1.84 +/- 0.46 [p0.05]). There were statistically significant differences between the groups in all measured parameters in intraparenchymal arteries (RI, 0.57 +/- 0.11 versus 0.63 +/- 0.05 [p0.001]; PI, 0.89 +/- 0.26 versus 1.09 +/- 0.16 [p0.001]) except PSV (7.11 +/- 1.55 versus 7.14 +/- 0.81 cm/s [p0.05]).Based on our findings, we suggest that renal circulation is not negatively influenced by intrauterine growth restriction in SGA neonates compared with AGA newborns.

Paediatric organ donation after circulatory death (DCD) is not a common practice in the UK. Nevertheless, recently it has been suggested in this journal as a method to optimise donation in line with recommendations of the Organ Donor Task Force (ODTF).1 On the other hand, some members of the paediatric intensive care community have called for a moratorium on DCD in children.2 While ethical guidance has been released by the Department of Health facilitating DCD in adults in the UK, no such guidance has been released for DCD in children.3 The ODTF suggests that discussions about donation should, if appropriate, become …

Background: Changes in renal arterial Doppler flow may identify parenchymal disease, but in newborns knowledge of normal physiological parameters is a prerequisite for correct interpretation. Objective: To evaluate renal blood flow in healthy newborns by means of Doppler US. Materials and methods: On the fourth day of life we examined 100 normal term newborn infants (200 kidneys). Blood flow in the central renal arteries was compared with that in the intraparenchymal arteries. Maximum systolic velocity (Vmax), end-diastolic velocity (Ved), mean flow velocity (Vmean), resistive index (RI) and pulsatility index (PI) were assessed. Results: All parameters were significantly higher in the central renal arteries than in the intraparenchymal arteries (RI 0.78±0.07 vs 0.62±0.05, P

Sir,I am delighted to have an opportunityto present the results of our study.In our previous Doppler study [1]we set normal values of renal circu-lation for a population of healthynewborns. Comparisons of Dopplerparameters of intraparenchymal (IP)renal arteries in various areas of thekidney in this age group have, how-ever,notyetbeenpublished.Availablesources of information are not suffi-cient [2, 3], and are not targeted to theneonatal period.Thirty physiologically normal termneonates (17 girls and 13 boys) withnegative perinatal history were en-rolled in this study. The examinationwas performed on day 4. No sedationwas required. Colour Doppler ultra-sound scanners were used with linear5–12-MHz multifrequency transduc-ers. Babies were examined in theprone position and kidneys werescanned from the dorsolateral view.Colour-flow mapping was performedto display renal blood flow. The lon-gest possible segment of the artery wasexamined under the optimal insonatingangle (less than 30°), keeping the sam-plevolumeassmallaspossible(1mm).IP arteries (arcuate and interlobulararteries) fromtheupperpole,themid-dlepartandthelowerpoleofthekidneywereassessed. Onemeasurement ofeacharterywasobtained.V