Understanding the Pathophysiology, Implications, and Treatment Options of Patent Ductus Arteriosus in the Neonatal Population

Abstract

Background: Patent ductus arteriosus (PDA) is the persistence of a fetal shunt between the pulmonary artery and the aorta. This structure normally closes in the first 3 days after birth; however, closure is delayed in up to 80% of infants born at 25 to 28 weeks of gestation. Persistent PDA results in pulmonary overcirculation and systemic hypoperfusion. Purpose: The purpose of this article is to review pathophysiology and treatment options for PDA. Methods: A literature review was conducted using PubMed, CINAHL, and Google Scholar (2013-2018). Search terms included neonate, PDA, pathophysiology, pharmacotherapy, nursing, ligation, indomethacin, ibuprofen, and acetaminophen (paracetamol). Results: Optimal treatment remains contentious. Options include conservative/medical, pharmacologic, and surgical management. Conservative/medical management includes mild fluid restriction, increased airway pressures, and supportive care. Pharmacologic treatment is accomplished using indomethacin, ibuprofen, or acetaminophen. Surgical intervention is by direct closure or by percutaneous ligation. Treatment may be prophylactic, presymptomatic, or symptomatic. Long-term morbidities associated with PDA include chronic lung disease, retinopathy of prematurity, and neurodevelopmental delay. Implications for Research: Absence of a universal scoring system for severity of PDA limits accuracy of comparisons among research studies. Lack of a consistent definition also makes it difficult to aggregate data for meta-analyses. Adoption of a consistent scoring system for hemodynamic significance would facilitate comparisons of outcomes among research studies. Implications for Practice: Clinicians should be aware of treatment options for PDA and their implications on neonatal outcomes. For nurses, anticipation of possible side effects is important for performance of focused assessments.

Anterior Minithoracotomy vs. Transcatheter Closure of Patent Ductus Arteriosus in Very Preterm Infants

“…Patent ductus arteriosus (PDA) is very common in preterm newborns and is inversely related to gestational age (weeks) (1). The incidence ranges from 60 to 80% for preterm infants born between 25 and 28 weeks and up to 90% for those born at 24 weeks (1,2).…”

“…Patent ductus arteriosus (PDA) is very common in preterm newborns and is inversely related to gestational age (weeks) (1). The incidence ranges from 60 to 80% for preterm infants born between 25 and 28 weeks and up to 90% for those born at 24 weeks (1,2). PDA can result in a significant left-to-right shunting and has been associated with neonatal morbidities: bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), acute renal failure, necrotizing enterocolitis (NEC), and retinopathy of prematurity (ROP) (1,(3)(4)(5)(6)(7).…”

“…The management of PDA remains controversial. Various treatment options and algorithms are available, but no robust recommendations exist (1,6). Medical therapy [mostly non-steroidal anti-inflammatory drugs (NSAIDs)] is usually the first-line option, with interventional closure reserved to medical treatment failure or contraindication (7).…”

Echocardiography-Guided Management of Preterms With Patent Ductus Arteriosus Influences the Outcome: A Cohort Study

“…Randomized controlled trials (RCTs) exploring the effects of a prophylactic treatment of PDA found that the occurrence of both death and long-term neurodevelopmental outcomes was not reduced. However, observational studies demonstrated the association between PDA exposure duration and long-term morbidities (14,32,33). In addition, retrospective studies found a relationship between symptomatic hs-PDA and morbidity combined with mortality (3).…”

“…We did not change the policies during the study period, but we cannot exclude the fact that unknown differences in clinical practice or changes in the medical staff composition may have influenced the outcomes of the study. We used previously described criteria for the definition of hs-PDA (1,5,19,32,46). Even if other parameters could be useful to define the hemodynamic significance of a PDA, information regarding ECHO findings on pulmonary overflow and systemic steal was not collected.…”