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The ductus arteriosus: a refined approach!
Arvind Sehgal1, Patrick J McNamara
1Monash Newborn, Monash Medical Centre, Clayton, Victoria, Australia.
Insights
Persistent ductus arteriosus in extremely preterm infants lacks treatment consensus. Targeted neonatal echocardiography may improve clinical decisions and patient outcomes for this common condition.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
Background:
- Ongoing patency of the ductus arteriosus is frequent in extremely preterm infants.
- Clinical significance and optimal treatment strategies remain debated.
- Uncertainty exists regarding spontaneous closure, neonatal morbidity, and long-term effects of intervention.
Purpose of the Study:
- To review current evidence on medical and surgical therapies for persistent ductus arteriosus.
- To explore the role of targeted neonatal echocardiography and biomarkers in refining treatment decisions.
- To discuss future directions in managing this condition.
Main Methods:
- Literature review of studies on ductus arteriosus management in preterm infants.
- Analysis of arguments for and against medical and surgical interventions.
- Evaluation of the potential of targeted neonatal echocardiography and biomarkers.
Main Results:
- Lack of consensus on clinical significance and treatment strategies.
- Need for improved methods to determine hemodynamic significance and patient selection.
- Preliminary data suggest targeted neonatal echocardiography can optimize outcomes.
Conclusions:
- Refining patient selection and hemodynamic assessment is crucial for managing persistent ductus arteriosus.
- Targeted neonatal echocardiography shows promise in guiding therapeutic interventions.
- Further research is needed to optimize treatment approaches and long-term outcomes.
Abstract:
Although ongoing patency of the ductus arteriosus is common in small extremely preterm infants, consensus is lacking regarding its clinical significance and treatment strategies. Literature regarding likelihood of spontaneous closure, impact on neonatal morbidity and long-term outcomes, and adverse effects of intervention has led to uncertainty as to the best course of action. Enhancing the determination of hemodynamic significance and refining patient selection for therapeutic intervention will streamline the decision-making process. Targeted neonatal echocardiography performed by the clinician has gained popularity worldwide, and preliminary data show that it has the potential to optimize patient outcomes. We review the arguments for and against medical and surgical therapy, explore how targeted neonatal echocardiography used in conjunction with biomarkers may refine the treatment approach, and consider future directions in the field.
