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Updated: Jun 20, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
[Patent ductus arteriosus in premature infants]
1Barne- og ungdomsklinikken, St. Olavs hospital og Institutt for laboratoriemedisin, Det medisinske fakultet, Norges teknisk-naturvitenskapelige universitet, 7006 Trondheim, Norway. dag.bratlid@ntnu.no
Insights
Patent ductus arteriosus in premature infants is often physiological, improving oxygenation. Treatment with COX-inhibitors increases risks like bronchopulmonary dysplasia without proven benefits.
Area of Science:
- Neonatal Physiology
- Cardiovascular Medicine
- Pediatric Surgery
Context:
- Traditionally, patent ductus arteriosus (PDA) in premature infants was treated due to perceived associations with pulmonary disease and bronchopulmonary dysplasia.
- Recent research challenges this long-held view, suggesting a paradigm shift in understanding PDA in this population.
Purpose:
- To review current literature on patent ductus arteriosus in premature infants.
- To re-evaluate the necessity and risks of PDA treatment in preterm neonates.
- To provide updated guidance on managing significant hemodynamic PDA.
Summary:
- Patent ductus arteriosus (PDA) in preterm infants may represent a physiological shunt, improving oxygenation in the early postnatal period.
- Evidence suggests PDA does not worsen pulmonary disease or increase risks of bronchopulmonary dysplasia, intraventricular hemorrhage, or necrotizing enterocolitis.
- Treatment with COX-inhibitors (indomethacin, ibuprofen) for PDA increases bronchopulmonary dysplasia risk without reducing other complications or mortality.
Impact:
- Current treatment strategies for PDA in premature infants, particularly COX-inhibitor use, may carry more risks than benefits.
- Management of hemodynamically significant PDA should prioritize fluid restriction, diuretics, and inotropic support before considering closure.
- Surgical closure of PDA is associated with neurosensory impairments in surviving infants, warranting careful consideration.
Background:
Patent ductus arteriosus in premature infants has often been treated because of its association with worsening of pulmonary disease and complications such as bronchopulmonary dysplasia. This view has now been challenged.
Material And Methods:
Relevant publications have been identified from review articles in international peer-reviewed journals. The articles have been retrieved through searches in the PubMed and Cochrane-databases.
Results:
Recent research has led to a new understanding of patent ductus arteriosus - a shift of paradigm has occurred. The condition implies that a shunt enables blood to flow from right to left in the first postnatal days (when pulmonary arterial pressure is high), and left to right in cases where significant pulmonary disease is present. The increased pulmonary blood flow improves oxygenation, and the condition should be considered as physiological in small premature infants. A patent ductus arteriosus does not worsen concomitant pulmonary disease or increase the risk of bronchopulmonary dysplasia, intraventricular hemorrhage, necrotising enterocolitis or other complications.
Interpretation:
Treatment of a patent ductus arteriosus with COX-inhibitors such as indomethacin and ibuprofen, increases the risk for bronchopulmonary dysplasia without reducing other complications or death. A large patent ductus arteriosus has significant hemodynamic effects and should be treated with fluid restriction, diuretics and inotropic drugs before closure is considered. Surgical closure of a patent ductus arteriosus is linked to neurosensory impairment in survivors.
