Abstract
The management of patent ductus arteriosus in the preterm infant is one of the areas of clinical care that is subjected to great practice variation. This is sadly one of the consequences of widespread adoption of closure of the patent ductus arteriosus by pharmacological or surgical means without subjecting the treatment approaches to rigorous randomized control trials. The diverse approaches to treatment currently range from early and aggressive closure of the ductus arteriosus to a conservative approach of watchful waiting for spontaneous closure. This review reviews the complex management strategies of the ductus arteriosus highlighting the areas of greatest controversy that need to be addressed in future trials to provide greatest benefit to the vulnerable preterm infant.
Highlights
Patent Ductus Arteriosus (PDA) is the most common cardiovascular abnormality in preterm neonates with a reported incidence as high as 60% in Extremely-Low-Birth-Weight (ELBW) newborns less than 28 weeks gestation [1]
The functional closure is facilitated by physiological rise in blood oxygen tension and cessation of placental function leading to loss of a major source for prostaglandin E2 (PGE2) [12]
A blinded comparison of clinical and echocardiographic parameters in a cohort of preterm infants showed that the signs of bounding pulses, active precordium, and systolic murmur were of reasonable specificity but very low sensitivity in the first 3 to 4 days of birth for diagnosis of an echocardiographically defined significant PDA [27]
Summary
Patent Ductus Arteriosus (PDA) is the most common cardiovascular abnormality in preterm neonates with a reported incidence as high as 60% in Extremely-Low-Birth-Weight (ELBW) newborns less than 28 weeks gestation [1]. While the Ductus Arteriosus (DA) is important for prenatal and immediate postnatal circulation, its persistence beyond the transitional period is associated with neonatal morbidity and mortality [2]. There is little evidence of consistent effect of treatment of PDA on major preterm morbidities and aggressive attempts to close the DA is being questioned [3,4]. The exact population of preterm babies that benefit from PDA treatment is unknown. Whether or not PDA should be treated, the timing of PDA treatment, mode, dose and duration of therapy is increasingly becoming a subject of great controversy
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