Spontaneous Closure of the Ductus Arteriosus in Preterm Infants: A Systematic Review

Abstract

The optimal management strategy for patent ductus arteriosus in preterm infants remains a topic of debate. Available evidence for a treatment strategy might be biased by the delayed spontaneous closure of the ductus arteriosus in preterm infants, which appears to depend on patient characteristics. We performed a systematic review of all literature on PDA studies to collect patient characteristics and reported numbers of patients with a ductus arteriosus and spontaneous closure. Spontaneous closure rates showed a high variability but were lowest in studies that only included preterm infants with gestational ages below 28 weeks or birth weights below 1,000 g (34% on day 4; 41% on day 7) compared to studies that also included infants with higher gestational ages or higher birth weights (up to 55% on day 3 and 78% on day 7). The probability of spontaneous closure of the ductus arteriosus keeps increasing until at least 1 week after birth which favors delayed treatment of only those infants that do not show spontaneous closure. Better prediction of the spontaneous closure of the ductus arteriosus in the individual newborn is a key factor to find the optimal management strategy for PDA in preterm infants.

Comment on: "Preterm Physiologically Based Pharmacokinetic Model, Part I and Part II”

“…While this might seem a smart approach as one can describe the data of all preterm neonates with one function, it has one major drawback-it does not take into account the effect of birth on maturational processes. Birth leads to complex physiological changes in multiple organ systems, independent from gestational age, including the cardiovascular, respiratory, hepatic and renal systems, all of which impact the maturation of the PK of drugs [4][5][6]. The effect of birth has been repeatedly shown in population PK models for both hepatically cleared [7][8][9] and renally cleared drugs [10,11].…”

“…For example, preterm neonates were assumed to have the same tissue blood flow to organs as full-term neonates and cardiac output was calculated based on bodyweight only, which does not seem very likely. In addition, a significantly higher chance of a patent ductus arteriosus (PDA) in children born at lower gestational ages [ 6 ] makes it likely that cardiac output also differs in children with and without PDA. Due to this, blood flow to organs might also vary.…”

SIMPLE: A Novel Scoring System for Predicting Hemodynamically Significant Patent Ductus Arteriosus Without Echocardiographic Evaluation in Extremely Low Birth Weight Infants

“…Although DA closes physiologically within 72 h of life in term infants, it often remains open due to several factors including immaturity, higher prostaglandin levels, respiratory distress, fluid overload, sepsis, and hypoxia in preterm infants (1)(2)(3). Spontaneous PDA closure rates for premature infants <28 weeks and/or 1,000 g was reported as 34 and 41%, on the 3rd and 7th days of life, respectively (4). Since PDA produces a left-to-right shunt, clinical findings of systemic stealing and pulmonary overflow develop after completion of the postnatal transition.…”

Early Urinary Metabolomics in Patent Ductus Arteriosus Anticipates the Fate: Preliminary Data

“…PDA closure can be performed pharmacologically or, in case of failure or contraindication, with surgical ligation or transcatheter closure (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18).…”

“…The risk of developing a persistence of ductal patency (PDA) increases with decreasing gestational age (GA), with relevant short- and long-term consequences in term of morbidity, especially in case of hemodynamically significant PDA (hsPDA) ( 1 , 7 , 8 ).…”