Management of Patent Ductus Arteriosus in Premature Infants

Abstract

Patency of the ductus arteriosus is required for fetal survival in utero. In infants born prematurely, ductus fails to close and shunt reverses from left to right. Incidence of patent ductus arteriosus (PDA) is inversely proportional to the gestational age. A large PDA (>1.5 mm diameter) with left to right shunt in very low birth weight infants can cause pulmonary edema, congestive heart failure, pulmonary hemorrhage and increase the risk for bronchopulmonary dysplasia. Attempts to prevent or close the duct by pharmacological or surgical methods have not changed the morbidity or the long term outcome. Pharmacological treatment with indomethacin or ibuprofen is successful in 75 to 80 % of infants but its use also exposes these infants to undesirable side effects like gastrointestinal bleeding, perforation and necrotizing enterocolitis. Prophylactic therapy with indomethacin or ibuprofen to prevent PDA has not altered the morbidity or long term outcome. Currently, there is a dilemma as to how to treat, when to treat and whom to treat. Recent literature suggests a trial of conservative management during the first week followed by selective use of anti-inflammatory drugs. Surgical ligation is reserved for infants who fail medical therapy and still remain symptomatic. Spontaneous closure of the PDA has been reported in up to 40-67 % of very low birth weight (VLBW) infants by 7 d. In this review authors discuss these controversies and propose a more rational approach.

Do Calcium and Potassium Levels Influence Ductal Patency in Preterm Infants?

“…PDA incidence, which was 41.2% in our study, varies in different studies between 33 and 60%. [2][3][4]8 Serum Ca 2þ and K þ levels and time to give intravenous Ca 2þ supplementation may contribute to the differences of PDA incidence in the literature.…”

A Mystery of Patent Ductus Arteriosus and Serum Osmolality in Preterm Infants

“…Many factors are already known to affect ductal patency after birth. 2,5,7,9,19,20 However, there are few studies on changes in serum osmolality in the early days of life. Limited information on the clinical effect of change in osmolality, particularly on ductal patency, exists.…”

The Role of Natriuretic Peptides in Management of Premature Infants with Hemodynamically Significant Patent Arterial Duct

“…Фармакологическое закрытие протока путем назначения нестероидного противовоспалительного препарата (НПВП) имеет свои преимущества, поскольку является альтернативным хирургическому и не имеет осложнений, сопряженных с оперативным лечением [35]. Вместе с тем в ряде исследований показано развитие осложнений, связанных с побочным действием ингибиторов циклооксигенезы при фармакологическом закрытии протока.…”