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Patent Ductus ArteriosusBeNeDuctusNCT02884219

Early Treatment Versus Expectative Management of PDA in Preterm Infants

A study testing Ibuprofen, Expectative Management and Indomethacin in people with Patent Ductus Arteriosus, run by Radboud University Medical Center at 13 sites in 2 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Much controversy exists about the optimal management of a patent ductus arteriosus (PDA) in preterm infants, especially in those born at a gestational age <28 weeks and/or a birth weight ≦1000 grams due to a lack of evidence for or against different approaches. A PDA has been associated with serious complications. Read more about this study

Who is it for?
Ages 1 hour to 3 days
Conditions the study is for
Patent Ductus Arteriosus
What is being tested?
Ibuprofen, Expectative Management and Indomethacin
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
273 participants
Where
13 sitesin 2 countries
Study dates
23 Dec 2016to 15 Mar 2022
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 1 hour to 3 days
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • PDA diameter > 1.5 mm and ductal (predominantly) left-to-right shunt
  • Signed informed consent obtained from parent(s) or representative(s)
  • Gestational age < 28 completed weeks

Who cannot join

  • Contraindication for administration of cyclooxygenase-inhibitors (COXi)
  • Persistent pulmonary hypertension (ductal right-to-left shunt ≧33% of cardiac cycle)
  • Congenital heart defect, other than PDA and/or patent foramen ovale (PFO)
  • Life-threatening congenital defects
  • Chromosomal abnormalities and/or congenital anomalies associated with abnormal neurodevelopmental outcome
  • Use of COXi prior to randomization

Trial locations and contacts

13 sites in 2 countries.

13 sites in 2 countries

Netherlands10 sites
  • Academic Medical Center

    Amsterdam

  • Free University Amsterdam

    Amsterdam

  • University Medical Center Groningen

    Groningen

  • Leiden University Medical Center

    Leiden

  • Maatricht University Medical Center

    Maastricht

  • Radboudumc Amalia Children's Hospital

    Nijmegen

  • Erasmus Medical Center Rotterdam

    Rotterdam

  • Wilhelmina Children's Hospital/UMCU

    Utrecht

  • Maxima Medical Center

    Veldhoven

  • Isala Kliniek Zwolle

    Zwolle

Other trials in Netherlands

Belgium3 sites
  • University Hospital Antwerp

    Antwerp

  • Hôpital Erasme - Clinique Universitaires de Bruxelles

    Brussels

  • University Hospital Brussels

    Brussels

Other trials in Belgium

About this study

Official title: Multi-center, Randomized Non-inferiority Trial of Early Treatment Versus Expectative Management of Patent Ductus Arteriosus in Preterm Infants (BeNeDuctus Trial - Belgium Netherlands Ductus Trial)

Much controversy exists about the optimal management of a patent ductus arteriosus (PDA) in preterm infants, especially in those born at a gestational age <28 weeks and/or a birth weight ≦1000 grams due to a lack of evidence for or against different approaches. A PDA has been associated with serious complications. However, a common finding is that medical and/or surgical treatment of a PDA seems not to reduce the risk of mortality or major morbidity. This might be related to the fact that a substantial portion of preterm infants are treated unnecessarily, because the ductus arteriosus (DA) might have closed spontaneously without any specific intervention. An expectative approach is gaining interest, although convincing evidence is still missing.

The objective of this study is to investigate whether in preterm infants <28 weeks' gestation with a PDA an expectative management is not inferior to early treatment with regard to the composite of mortality and/or necrotizing enterocolitis (NEC) and/or bronchopulmonary dysplasia (BPD) at a postmenstrual age of 36 weeks.

Read the detailed description

After obtainment of informed consent the first echocardiographic evaluation is performed at a postnatal age of 24-72 hours. In absence of exclusion criteria patients will only be randomized when a PDA is present, the transductal diameter measures >1.5 mm and a blood flow pattern with a predominantly left-to-right shunt is observed. Randomization will assign the neonate to either the medical treatment (COXi) arm or the expectative PDA management arm.

It is essential that neonatal management is similar in both arms with the exception of the prescription of COX-inhibition and routine echocardiographic examination after a course of COXi in the medical treatment arm.

Medical treatment arm When the patient is allocated to the medical treatment arm COX-inhibition is prescribed and started as soon as possible, but no later than 3 hours after the echocardiogram.

The investigators prefer to use Ibuprofen (IBU) for COX-inhibition in this study. Aside from the above mentioned reasons the investigators are confronted with an actual lack of availability of indomethacin in most centers in the Netherlands and Belgium. However, Indomethacin (INDO) can be prescribed for medical ductal closure if this is preferred by a participating center.

The dosing schemes for IBU and INDO are according the local guidelines. For the first week of life the birth weight is used for calculation of the COXi dosage. After a postnatal age of 7 days the actual weight is used for dose calculation, except when the actual weight is still less than the birthweight.

The treatment described above is considered standard of care in many NICU's worldwide. It should be noted that there is no modification of the commonly advised usage of IBU in this study. There are reports that suggest that an high dose of IBU might be more effective in ductal closure in preterm infants, especially in those less than 27 weeks' gestation. However, in a systematic review one refrained from recommendations regarding high dose IBU because of the limited number of patients enrolled in studies.

The preferred route of administration of IBU is intravenously. However, this is at the disposal of the attending physician, since enteral administration appears at least as effective.

Echocardiographic reevaluation is performed at least 12 hours after the last (3rd) dose of the first COXi course. If the ductus arteriosus is found to be closed, no further analysis or treatment is needed regarding the ductus arteriosus. A ductus arteriosus is considered to be closed when it can't be visualized using color Doppler imaging or when the transductal diameter measures less than 0.5 mm.

When the ductus arteriosus hasn't closed, a second course of COX-inhibition is started at least 24 hours after the third dose of the first course. COXi dosages are similar to the first course.

Twelve to 24 hours after the last dose of the second course (6th gift) echocardiography is performed. If the ductus arteriosus is found to be closed, no further analysis or treatment is needed regarding the ductus arteriosus.

When the duct failed to close after two courses of COXi (6 doses in total) and the PDA is judged to be still hemodynamically significant, ductal ligation can be considered, only when the so-called 'ligation criteria' are met.

Expectative PDA management arm Patients randomized to the expectative management arm will not receive any COXi and PDA management in this group can be characterized as "watchful waiting". This is not a unique approach, since a restrictive approach towards a PDA is increasingly used in many centers worldwide without the observation of an increased risk of neonatal mortality and morbidity, such as severe chronic lung disease (CLD), intraventricular hemorrhage (IVH), NEC and retinopathy of prematurity (ROP).

It is essential that neonatal management is similar in both study arms with the exception of the prescription of COXi and echocardiography at the end of the drug course in the medical treatment arm. It is of the upmost importance that NO extra interventions are to be undertaken with the intention to conservatively prevent or treat a (suspected) PDA in the expectative arm, such as fluid restriction and diuretics for that reason. Moreover, it should be noted that there is insufficient evidence that fluid restriction and/or diuretics are of any benefit in patients with a (suspected) PDA.

When during the first week the attending physician is of the opinion that the patient is in danger, when it's deprived from treatment with COXi, open label treatment can only be considered when the 'open label criteria' are met.

Being tested
Ibuprofen, Expectative Management, Indomethacin
Keywords
Early treatment, Expectative treatment, Patent ductus arteriosus, Preterm
Medical subject headings
Ductus Arteriosus, Patent, Premature Birth

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • IbuprofenDrug

    Also called Cyclooxygenase Inhibitor

    In the medical treatment (COXi) arm the intention is to close the ductus arteriosus.

  • Expectative ManagementOther

    Also called Conservative management

    Expectative PDA management is characterized as 'watchful waiting'. No intervention is initiated with the intention to close a PDA.

  • IndomethacinDrug

    Also called Cyclooxygenase Inhibitor

    In the medical treatment (COXi) arm the intention is to close the ductus arteriosus.

Study groups in NCT02884219
Study groupRoleWhat they receive
Early Treatment with cyclooxygenase inhibitorsActive comparatorTreatment of PDA that starts within the first 3 days of life using cyclooxygenase-inhibitors (Ibuprofen or Indomethacin)
Receives: Drug: Ibuprofen; Drug: Indomethacin
Expectative TreatmentSham comparatorExpectative PDA management is characterized as 'watchful waiting'. No intervention is initiated with the intention to close a PDA.
Receives: Other: Expectative Management

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Composite of mortality, and/or NEC, and/or BPD

    The primary outcome is the composite of mortality, and/or NEC (Bell stage ≥ IIa), and/or BPD, defined as the need for supplemental oxygen need, all at a postmenstrual age of 36 completed weeks.

    Measured: At a postmenstrual age of 36 completed weeks

Secondary outcomes (3)
  1. Short term sequelae of cardiovascular failure

    At the time of discharge the incidence of cardiovascular failure is calculated

    Measured: Day 1 up to 3 months

  2. Short term sequelae of adverse events

    At the time of discharge the number of all adverse events are calculated

    Measured: Day 1 up to 3 months

  3. Long-term neurodevelopmental consequences assessed with BSID-III-NL.

    All patients in this study will be included in the National Neonatal Follow Up Program and are therefore seen at a corrected age of 24 months. Their neurodevelopment is assessed with the Bayley Scales of Infant and Toddler Development, Third Dutch Edition (BSID-III-NL).

    Measured: Assessed at an corrected age of 2 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted30 Aug 2016 (estimated)
  2. Study start23 Dec 2016
  3. Primary completion15 Mar 2022
  4. Study completion15 Mar 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
273 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02884219
Sponsor's protocol ID
843002622
Acronym
BeNeDuctus
Status last verified
Apr 2020
First submitted
1 Apr 2016
Last updated
3 Jul 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: The data will be made available after an embargo period

Publications

  • Hundscheid T, Onland W, Kooi EMW, Vijlbrief DC, de Vries WB, Dijkman KP, van Kaam AH, Villamor E, Kroon AA, Visser R, Mulder-de Tollenaer SM, De Bisschop B, Dijk PH, Avino D, Hocq C, Zecic A, Meeus M, de Baat T, Derriks F, Henriksen TB, Kyng KJ, Donders R, Nuytemans DHGM, Van Overmeire B, Mulder AL, de Boode WP; BeNeDuctus Trial Investigators. Expectant Management or Early Ibuprofen for Patent Ductus Arteriosus. N Engl J Med. 2023 Mar 16;388(11):980-990. doi: 10.1056/NEJMoa2207418. Epub 2022 Dec 6.

    PubMed 36477458
  • Apers WMJ, Hundscheid T, Kooi EMW, Onland W, Vijlbrief D, Steiner K, Donders R, Mulder AL, de Boode WP; BeNeDuctus Trial Investigators. Long-Term Outcomes of Expectant Management versus Early Ibuprofen for Patent Ductus Arteriosus: 24-Month Follow-Up of the BeNeDuctus Trial. J Pediatr. 2026 Sep 17;299:115292. doi: 10.1016/j.jpeds.2026.115292. Online ahead of print.

    PubMed 42637114
  • Hundscheid T, Donders R, Onland W, Kooi EMW, Vijlbrief DC, de Vries WB, Nuytemans DHGM, van Overmeire B, Mulder AL, de Boode WP; BeNeDuctus trial study group. Multi-centre, randomised non-inferiority trial of early treatment versus expectant management of patent ductus arteriosus in preterm infants (the BeNeDuctus trial): statistical analysis plan. Trials. 2021 Sep 15;22(1):627. doi: 10.1186/s13063-021-05594-x.

    PubMed 34526095
  • Hundscheid T, Onland W, van Overmeire B, Dijk P, van Kaam AHLC, Dijkman KP, Kooi EMW, Villamor E, Kroon AA, Visser R, Vijlbrief DC, de Tollenaer SM, Cools F, van Laere D, Johansson AB, Hocq C, Zecic A, Adang E, Donders R, de Vries W, van Heijst AFJ, de Boode WP. Early treatment versus expectative management of patent ductus arteriosus in preterm infants: a multicentre, randomised, non-inferiority trial in Europe (BeNeDuctus trial). BMC Pediatr. 2018 Aug 4;18(1):262. doi: 10.1186/s12887-018-1215-7.

    PubMed 30077184

Questions about this trial

What is this clinical trial studying?

A study testing Ibuprofen, Expectative Management and Indomethacin in people with Patent Ductus Arteriosus, run by Radboud University Medical Center at 13 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 3 Jul 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 13 sites in Netherlands, Belgium. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Composite of mortality, and/or NEC, and/or BPD (time frame: At a postmenstrual age of 36 completed weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02884219, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Jul 2023.

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