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Open Access Highly Accessed Research article

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

Khalid M AlFaleh1*, Eman Al Luwaimi1, Turki M AlKharfi1 and Saleh A Al-Alaiyan2

Author Affiliations

1 Department of Pediatrics (Division of Neonatology), College of Medicine, King Saud University, Riyadh, Saudi Arabia

2 Department of Pediatrics (Division of Neonatology), King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

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BMC Pediatrics 2011, 11:78  doi:10.1186/1471-2431-11-78

Published: 3 September 2011

Abstract

Background

Decision Aids (DA) are well established in various fields of medicine. It can improve the quality of decision-making and reduce decisional conflict. In neonatal care, and due to scientific equipoise, neonatologists caring for extreme low birth weight (ELBW) infants are in need to elicit parents' preferences with regard to the use of indomethacin therapy in ELBW infants. We aimed to develop a DA that elicits parents' preferences with regard to indomethacin therapy in ELBW infants.

Methods

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.

Results

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).

Conclusion

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.

Keywords:
Indomethacin; patent ductus arteriosus; intraventricular hemorrhage; premature infants