title: A prospective study of maternal preference for indomethacin prophylaxis versus symptomatic treatment of a patent ductus arteriosus in preterm infants.
abstract: BACKGROUND
  The management of a patent ductus arteriosus in preterm infants continues to be debated among neonatologists due to the absence of concrete evidence that precisely weighs the long term outcomes of active, early intervention against a conservative approach. In the majority of institutions, parents are encouraged to play an active role in the complex, decision -making processes with regard to the care of their infants. The objective of this study is to elicit maternal preferences for indomethacin prophylaxis versus treatment of a patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants, utilizing a decision aid instrument (DAI).
  
  
  METHODS
  Healthy and high risk pregnant women at 23-28 weeks gestation, and mothers of admitted ELBW infants were enrolled. A computer based, validated DAI was utilized during interviews. The DAI first provides information about prematurity and concurrent morbidities with comprehensive facts of the pros and cons about prophylactic versus treatment options. It subsequently coaches participants how to select values and preferences based on their decisions. A 17-item questionnaire assessed and valued each short and long term morbidity of extreme prematurity and preferred choice for PDA management.
  
  
  RESULTS
  Two hundred ninety nine subjects were enrolled; 75% were healthy women at 23-28 weeks gestation, 19% were high risk and 6% recently delivered an ELBW infant. Eighty-two percent preferred a prophylactic indomethacin strategy versus symptomatic treatment for the management of PDA. Across a spectrum of potential morbidities, the occurrence of severe intraventricular hemorrhage was viewed by mothers as the most un-wanted outcome irrespective of the two proposed options.
  
  
  CONCLUSIONS
  In contrast to neonatal practitioners, mothers who used this particular DAI strongly endorsed prophylactic indomethacin versus a treatment intervention for the management of PDA in preterm infants.
authors.affiliation: Department of Pediatrics (Division of Neonatology), College of Medicine, King Saud University, Riyadh, Saudi Arabia. kfaleh@ksu.edu.sa.
authors.forename: Khalid
authors.initials: K
authors.lastname: AlFaleh
authors.affiliation: Department of Pediatrics (Division of Neonatology), College of Medicine, King Saud University, Riyadh, Saudi Arabia. e_allwaimi@yahoo.com.
authors.forename: Eman
authors.initials: E
authors.lastname: Alluwaimi
authors.affiliation: Department of Pediatrics, King Fahad Medical City, Riyadh, Saudi Arabia. ahlam.alossaimi@gmail.com.
authors.forename: Ahlam
authors.initials: A
authors.lastname: AlOsaimi
authors.affiliation: Department of Pediatrics (Division of Neonatology), College of Medicine, King Saud University, Riyadh, Saudi Arabia. sheikha90@gmail.com.
authors.forename: Sheikha
authors.initials: S
authors.lastname: Alrajebah
authors.affiliation: Department of Pediatrics (Division of Neonatology), College of Medicine, King Saud University, Riyadh, Saudi Arabia. Beshayr0882@gmail.com.
authors.forename: Bashayer
authors.initials: B
authors.lastname: AlOtaibi
authors.affiliation: Department of Pediatrics (Division of Neonatology), College of Medicine, King Saud University, Riyadh, Saudi Arabia. fatima.alrasheed@hotmail.com.
authors.forename: Fatima
authors.initials: F
authors.lastname: AlRasheed
authors.affiliation: Department of Pediatrics (Division of Neonatology), College of Medicine, King Saud University, Riyadh, Saudi Arabia. tkharfi@ksu.edu.sa.
authors.forename: Turki
authors.initials: T
authors.lastname: AlKharfi
authors.affiliation: Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, ON, Canada. paes@mcmaster.ca.
authors.forename: Bosco
authors.initials: B
authors.lastname: Paes
mesh_terms: D002317:Cardiovascular Agents / Q000627:therapeutic use*; D003661:Decision Support Techniques; D004374:Ductus Arteriosus, Patent / Q000188:drug therapy* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use*; D052577:Infant, Extremely Low Birth Weight; D009035:Mothers / Q000523:psychology*; D010358:Patient Participation; D011247:Pregnancy; D011446:Prospective Studies
chemical_list: D002317:Cardiovascular Agents; D007213:Indomethacin