Diagnosis and Management of Patent Ductus Arteriosus

Gillam-Krakauer, Maria; Reese, Jeff

doi:10.1542/neo.19-7-e394

Cited by 84 publications

(77 citation statements)

References 68 publications

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“…On the one hand, LA/aortic root ratio above 1.5 is considered indicative of hsPDA, and our result was 1.3, with statistical difference only when compared with the group with no PDA. But on the other hand, PDA diameter and flow velocity met the definitions of hsPDA, and PDA diameter/ weight was above 1.4, which is considered a better measure of ductal shunt in previous studies [19,22]. In addition, there were clinical and laboratory measures showing that the study group did have a hemodynamic clinically significant PDA.…”

Section: Discussionmentioning

confidence: 77%

The effect of patent ductus arteriosus on coronary artery blood flow in premature infants: a prospective observational pilot study

et al. 2020

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Objective To compare coronary flows between premature infants with and without hemodynamically significant patent ductus arteriosus (hsPDA) and to determine if coronary flow is influenced by medical PDA treatment.Design Prospective, observational pilot study. Forty-three infants <32 weeks gestation underwent echocardiography when routinely indicated. Study group included infants with hsPDA requiring treatment. Comparison groups included infants with nonsignificant PDA and infants without PDA. Results The study group (n = 13), compared with the comparison groups with nonsignificant PDA (n = 12) and without PDA (n = 18) had higher troponin levels (p = 0.003 and 0.004, respectively). In infants with hsPDA compared with infants with no PDA there was a significant increase in myocardial oxygen demand and decrease in left main coronary artery flow, with nonsignificant increase in cardiac output. Conclusions Decrease in coronary artery flows and higher troponin values may suggest a "steal effect," not allowing to meet the elevated myocardial oxygen demand in infants with hsPDA.

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Section: Discussionmentioning

confidence: 77%

The effect of patent ductus arteriosus on coronary artery blood flow in premature infants: a prospective observational pilot study

et al. 2020

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“…Over the past decade, much of what we thought we knew to be true regarding the PDA in the preterm neonate has been re-evaluated leading to new approaches to the clinical evaluation and treatment of the PDA. 5 In this context, we felt it was important to re-examine the association between widened pulse pressure and PDA. Our data indicate that, during the first week of life, diastolic pressure-and not pulse pressure-is best correlated with ductal patency.…”

Section: Discussionmentioning

confidence: 99%

“…Each of these parameters is graded from 0 to 2, yielding a composite score ranging from 0 (closed ductus) to 8 (most significant). Ductal status is defined according to this initial echocardiogram as either closed (a composite score of 0) or open but hemodynamically insignificant PDA (composite score of [1][2][3][4][5] or hsPDA (composite score of !6). Prophylactic treatment with ibuprofen/indomethacin is not given in our institution.…”

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confidence: 99%

Wide Pulse Pressure Is Not Associated with Patent Ductus Arteriosus in the First Week of Life

et al. 2019

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Objectives Widened pulse pressure is generally associated with patent ductus arteriosus (PDA). Surprisingly, this is often not true for preterm infants during the first week of life when systolic and diastolic pressures are both reduced and pulse pressure may remain unchanged. Study Design This is a retrospective, observational review of individual blood pressure (BP) parameters preterm neonates <30 weeks' gestational age during the first week of life as correlated with ductal patency and severity. Results Sixteen preterm neonates had a closed ductus on initial echocardiogram during the first week of life; 30 had a PDA that was open but hemodynamically insignificant; and 16 were found to have a hemodynamically significant PDA. Pulse pressure showed no correlation (p = 0.266) with the degree of ductal patency, whereas diastolic BP was best correlated with ductal severity (p < 0.001). Conclusion We found that low diastolic pressures are better correlated with ductal patency and severity than is pulse pressure in preterm neonates during the first week of life.

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“…Most of pharmacologic treatments reported in the literature were given before the 14 th day of postnatal life [13][14][15][29][30][31][32][33][34][35][36]. According to Chuan-Zhong Yang in China, the rate of ductal closure after indomethacin therapy dropped from 85% in the first 24 hours of life to only 48% when the treatment was started at the 72 nd hour [28].…”

Section: Discussionmentioning

confidence: 99%

Successful Closure of Patent Ductus Arteriosus by Late Pharmacologic Treatment in a Small Preterm Infant

Theodore¹,

Paul²,

Bama³

et al. 2019

AJP

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The ductus arteriosus (DA) is a temporary communicative pathway that connects the pulmonary artery to the aorta during foetal life. Although usually closing on its own in the initial days of postnatal life, the persistent patency of the DA is common in preterm or low birth weight babies, and can lead to life-threatening complications. Early diagnosis and pharmacologic management of patent ductus arteriosus (PDA) could prevent further need for invasive surgery or transcatheter intervention. Pharmacologic treatment for PDA closure in preterm infants is achieved by cyclooxygenase inhibitors (COXi) and paracetamol. However, their effectiveness is fully demonstrated when they are used early within the first week of postnatal life. We report here the case of a severe preterm infant of 27 weeks gestation age with extremely low birth weight (995g), who had a PDA with moderate to severe shunting closed after late administration of intravenous ibuprofen. Ibuprofen was started on postnatal day 40, and the PDA got closed after a three-day course of treatment. No complication related to the treatment was reported. The DA remained closed when the infant was seen on review for echocardiography at the age of six months. Wherever cardiac surgery and transcatheter intervention are not available nor affordable, possible effectiveness of COXi even in case of late diagnosis of PDA, offers an unexpected opportunity to cure at a very cheaper cost, one of the commonest congenital heart disease.

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Diagnosis and Management of Patent Ductus Arteriosus

Cited by 84 publications

References 68 publications

The effect of patent ductus arteriosus on coronary artery blood flow in premature infants: a prospective observational pilot study

The effect of patent ductus arteriosus on coronary artery blood flow in premature infants: a prospective observational pilot study

Wide Pulse Pressure Is Not Associated with Patent Ductus Arteriosus in the First Week of Life

Successful Closure of Patent Ductus Arteriosus by Late Pharmacologic Treatment in a Small Preterm Infant

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