Learning to live with patency of the ductus arteriosus in preterm infants

Benitz, William Ε.

doi:10.1038/jp.2010.175

Cited by 45 publications

(34 citation statements)

References 77 publications

(90 reference statements)

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“…First, deciding not to intervene routinely to achieve earlier closure of the ductus should not imply that consequences of ductal patency can be completely ignored. 55 Although many strategies for management of the consequences of PDA have been proposed, none have been subjected to systematic evaluation in clinical trials, which are urgently needed to guide management of these infants. Studies of interventions designed to limit excessive pulmonary blood flow (red cell transfusion, increased positive airway pressure, correction of alkalosis, avoidance of pulmonary vasodilators such as oxygen or nitric oxide), to increase systemic cardiac output (dopamine, captopril, avoidance of hypovolemia), to ameliorate pulmonary edema (fluid restriction, diuretics, correction of hypoproteinemia), or to minimize confounding insults (nephrotoxic drugs, systemic infection/inflammation, hypoxemia, hypocarbia) may be appropriate.…”

Section: Clinical Trial Opportunitiesmentioning

confidence: 99%

Patent Ductus Arteriosus in Preterm Infants

Benitz¹,

Watterberg²,

Aucott³

et al. 2016

Pediatrics

295

206

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Despite a large body of basic science and clinical research and clinical experience with thousands of infants over nearly 6 decades, 1 there is still uncertainty and controversy about the signifi cance, evaluation, and management of patent ductus arteriosus in preterm infants, resulting in substantial heterogeneity in clinical practice. The purpose of this clinical report is to summarize the evidence available to guide evaluation and treatment of preterm infants with prolonged ductal patency in the fi rst few weeks after birth.

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Section: Clinical Trial Opportunitiesmentioning

confidence: 99%

Patent Ductus Arteriosus in Preterm Infants

Benitz¹,

Watterberg²,

Aucott³

et al. 2016

Pediatrics

295

206

View full text Add to dashboard Cite

show abstract

“…If a systemic inflammatory response is responsible for both ductal patency and other complications of prematurity, for example, immunomodulatory measures might prove useful. Second, the haemodynamic consequences of a large left-to-right ductal shunt may require active management 26. Excessive pulmonary blood flow might be reduced by distending airway pressure, permissive hypercapnia, minimising inspired oxygen concentrations, or transfusion to maintain haematocrits near or above 50%.…”

mentioning

confidence: 99%

Patent ductus arteriosus: to treat or not to treat?

Benitz

2011

Arch Dis Child Fetal Neonatal Ed

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Persistent patency of the ductus arteriosus in the preterm infant is associated with numerous morbidities, including higher rates of bronchopulmonary dysplasia and increased mortality. These strong associations have led to widespread use of cyclooxygenase inhibitors and surgical ligation to achieve ductal closure in the expectation that closing the ductus will reduce these complications. Each of these interventions has its own associated adverse effects. Neither individual randomised controlled trials nor meta-analyses of those trials have been able to demonstrate longterm benefi ts of these treatments despite their effi cacy in inducing ductal closure and reducing the need for ductal ligation. Despite the potential shortcomings of those trials, they provide substantial cumulative evidence that early, routine treatment to close a persistently patent ductus arteriosus in preterm infants does not improve outcomes and should therefore be abandoned. Future trials of these interventions for patent ductus management should address different questions. Persistence of ductal patency should be considered a sign of rather than a direct cause of the several morbidities with which it is clearly associated. Practitioners should tolerate ductal patency and learn to manage its causes and consequences rather than focusing on achievement of ductal closure.

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“…[59868788] This has been accompanied by a secular trend away from surgical ligation and toward a permissive (or “conservative”) approach to the PDA, incorporating the use of fluid restriction, diuretics and increased positive end-expiratory pressure. The goal is to limit shunt volume and/or improve an infant's physiological tolerance of the PDA without trying to achieve ductal closure using medication or surgery.…”

Section: Permissive Approach To the Patent Ductus Arteriosus: Are We mentioning

confidence: 99%

Patent ductus arteriosus ligation and adverse outcomes: Causality or bias?

Weisz

McNamara

2014

J Clin Neonatol

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Observational studies have associated patent ductus arteriosus (PDA) ligation in preterm infants with increased chronic lung disease (CLD), retinopathy of prematurity, and neurodevelopmental impairment at long-term follow-up. Although the biological rationale for this association is incompletely understood, there is an emerging secular trend toward a permissive approach to the PDA. However, insufficient adjustment for postnatal, pre-ligation confounders, such as intraventricular hemorrhage and the duration and intensity of mechanical ventilation, suggests the presence of residual bias due to confounding by indication, and obliges caution in interpreting the ligation-morbidity relationship. A period of conservative management after failure of medical PDA closure may be considered to reduce the number of infants treated with surgery. Increased mortality and CLD in infants with persistent symptomatic PDA suggests that surgical ligation remains an important treatment modality for preterm infants.

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Learning to live with patency of the ductus arteriosus in preterm infants

Cited by 45 publications

References 77 publications

Patent Ductus Arteriosus in Preterm Infants

Patent Ductus Arteriosus in Preterm Infants

Patent ductus arteriosus: to treat or not to treat?

Patent ductus arteriosus ligation and adverse outcomes: Causality or bias?

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