Patent Ductus Arteriosus: The Conundrum and Management Options

Abstract

Patency of the ductus arteriosus (PDA) in preterm infants is associated with increased morbidity and mortality. However, there has been growing controversy regarding the approach to its management. Various medical treatment approaches thus far have failed to demonstrate any improvement in clinical outcomes such as necrotising enterocolitis, bronchopulmonary dysplasia or death, and surgical closure has been associated with neurodevelopmental impairment. This has led to uncertainty about whether to treat or not to treat a PDA, and an increasing number of clinicians are following a more conservative approach of a “wait and watch” policy due to uncertainty. Clinicians with hemodynamic interest are however concerned about the side effects of persistent PDA. With the availability of bedside echocardiography, they have started assessing the PDA before it is symptomatic in the first 2–3 days and commencing medical treatment in a select population of extremely preterm babies who are at highest risk of complications due to persistent PDA. Other biomarkers are also studied to identify PDA that might benefit from closure. The oral route of ibuprofen administration has also been explored with promising early results suggesting improved efficacy in closure of PDA in a select population. With concerns about surgical ligation, newer techniques such as percutaneous trans-venous device closure are now being used, as small devices are now available that can be used in babies as small as 700 g.