Hemodynamically significant patent ductus arteriosus and the development of bronchopulmonary dysplasia

Abstract

Patent ductus arteriosus (PDA) is prevalent in premature newborns and has been linked to the development of bronchopulmonary dysplasia (BPD), a serious pulmonary complication of premature birth. Although a causal relationship has not been proven, the link is greatest among infants born at lower gestational age who are treated with mechanical ventilation in the presence of a large ductal shunt. Despite strong association in epidemiological studies, treatment of a patent ductus arteriosus has not been shown to prevent BPD, and some therapies may increase the risk of BPD. We describe preclinical and clinical data demonstrating the association of a PDA with BPD, highlight the effects of surgical and pharmacological treatment, and explore the implications of recent clinical trials for the management of PDA in the premature newborn.

Conservative Non-intervention Approach for Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants

“…Persistent patent ductus arteriosus (PDA) in premature infants has been known to be associated with increased mortality and morbidities including bronchopulmonary dysplasia (BPD), and necrotizing enterocolitis (NEC) (1-3); however, there is minimal evidence to support their causal relationship (3)(4)(5). Although it is traditional to manage PDA with nonsteroidal anti-inflammatory agents such as indomethacin, ibuprofen and recently acetaminophen (6), and/or surgical ligation, definite evidence supporting the benefits of these therapies over the conservative non-intervention approach is lacking (7)(8)(9), and they may even be associated with adverse effects (10)(11)(12)(13)(14).…”

Minimally Invasive Surfactant Administration for the Treatment of Neonatal Respiratory Distress Syndrome: A Multicenter Randomized Study in China

“…A hemodynamically relevant PDA has been associated with pulmonary edema and respiratory compromise has been associated with a resultant higher incidence of BPD. Excessive pulmonary blood flow via the pulmonary vascular bed results in an interrupted lung structure similar to the characteristic BPD changes in immature infants with extremely low birth weight (33). Therefore, a more stable hemodynamics with less PDA could explain the significant reduction in morbidity of BPD in the MISAs group in the subgroup analysis.…”

Morbidity associated with Patent Ductus Arteriosus in Preterm Newborns: A Retrospective Case-Control Study

“…Prolonged mechanical ventilation could be also a condition that may have increased the risk of BPD in enrolled newborns affected by hs-PDA. It has been well described by Willis et al that prolonged mechanical ventilation in preterm newborns can determine alveolar simpli cation leading to increased likely to develop BPD [31]. Epidemiological studies demonstrated a strong association between the presence of a PDA and the development of BPD [31].…”