Controversies in Management of Patent Ductus Arterious in the Preterm Infant

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.

Practice variation in the management of patent ductus arteriosus in extremely low birth weight infants in the United States: Survey results among cardiologists and neonatologists

“…There is ongoing debate on how to manage PDA in preterm infants . As illustrated in this survey, 50% of the neonatologists are unsure of potential benefits of PDA closure in ELBW infants.…”

“…A Patent ductus arteriosus (PDA) is found in 40‐60% of extremely low birth weight (ELBW—birth weight < 1 kg), preterm infants . Yet, neither is there a consensus on managing ELBW infants with a PDA, nor do we know which infant will benefit from treatment . Incidences of necrotizing enterocolitis (NEC), chronic lung disease (CLD), and intraventricular hemorrhage (IVH) are associated with PDA, as pulmonary over circulation occurs and systemic circulation is hypoperfused .…”

“…1 Yet, neither is there a consensus on managing ELBW infants with a PDA, 2 nor do we know which infant will benefit from treatment. [2][3][4] Incidences of necrotizing enterocolitis (NEC), chronic lung disease (CLD), and intraventricular hemorrhage (IVH) are associated with PDA, [5][6][7] as pulmonary over circulation occurs and systemic circulation is hypoperfused. 6,7 Management practices can vary from watchful waiting for closure, medical therapy with Cox inhibitors, surgical ligation, 3 and transcatheter PDA closure (TCPC).…”

“…[2][3][4] Incidences of necrotizing enterocolitis (NEC), chronic lung disease (CLD), and intraventricular hemorrhage (IVH) are associated with PDA, [5][6][7] as pulmonary over circulation occurs and systemic circulation is hypoperfused. 6,7 Management practices can vary from watchful waiting for closure, medical therapy with Cox inhibitors, surgical ligation, 3 and transcatheter PDA closure (TCPC). [8][9][10][11] This article presents some of the considerations which determine the modality and timing of PDA treatment, if any, from a sample of 100 prominent cardiologists and neonatologists in the United States.…”

Controversies in the Management of Patent Ductus Arteriosus in Preterm Infants

“…PDA is present in 40-60 percent of preterms with its incidence inversely proportional to the gestational age [2]. The ductus arteriosus serves as an important physiological communication in prenatal life but its persistence in postnatal life is considered pathological due to its associated morbidity and mortality.…”