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Updated: May 22, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Patent ductus arteriosus in premature neonates
Olachi J Mezu-Ndubuisi1, Ghanshyam Agarwal, Aarti Raghavan
1Division of Neonatology, Department of Pediatrics, University of Illinois at Chicago, Chicago, IL 60612, USA.
Insights
Persistent ductus arteriosus (PDA) in premature infants causes significant health issues. Early identification of at-risk infants can guide treatment, balancing intervention with expectant management for potential spontaneous closure.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Perinatology
Background:
- Patent ductus arteriosus (PDA) is a common complication in premature infants, particularly those born before 28 weeks gestation.
- Hemodynamically significant PDA contributes to severe morbidity, including respiratory distress, cardiovascular instability, and increased mortality.
- PDA is linked to serious long-term complications such as bronchopulmonary dysplasia, intraventricular hemorrhage, and cerebral palsy.
Purpose of the Study:
- To review the pathophysiology, clinical presentation, and assessment of hemodynamic significance in PDA of prematurity.
- To critically evaluate the evidence supporting current medical and surgical management strategies for PDA.
- To explore the potential for improved identification of at-risk infants to guide treatment decisions.
Main Methods:
- Systematic review of existing literature on PDA in premature infants.
- Appraisal of evidence quality for medical (cyclo-oxygenase inhibitors) and surgical (ligation) interventions.
- Analysis of pathophysiology and clinical features associated with PDA.
Main Results:
- Cyclo-oxygenase inhibitors (indomethacin, ibuprofen) are primary medical treatments for PDA prophylaxis and rescue therapy.
- Surgical ligation is effective for infants unresponsive to medical management.
- Both medical and surgical treatments carry significant adverse effects.
Conclusions:
- While medical and surgical treatments effectively close the ductus arteriosus, their associated risks necessitate careful consideration.
- Spontaneous closure of PDA occurs in some premature infants.
- Improved early identification of infants likely to develop symptomatic PDA is crucial for optimizing treatment strategies and enabling expectant management where appropriate.
Abstract:
Persistent patency of the ductus arteriosus is a major cause of morbidity and mortality in premature infants. In infants born prior to 28 weeks of gestation, a haemodynamically significant patent ductus arteriosus (PDA) can cause cardiovascular instability, exacerbate respiratory distress syndrome, prolong the need for assisted ventilation and increase the risk of bronchopulmonary dysplasia, intraventricular haemorrhage, renal dysfunction, cerebral palsy and mortality. We review the pathophysiology, clinical features and assessment of haemodynamic significance, and provide a rigorous appraisal of the quality of evidence to support current medical and surgical management of PDA of prematurity. Cyclo-oxygenase inhibitors such as indomethacin and ibuprofen remain the mainstay of medical therapy for PDA, and can be used both for prophylaxis as well as for rescue therapy to achieve PDA closure. Surgical ligation is also effective and is used in infants who do not respond to medical management. Although both medical and surgical treatment have proven efficacy in closing the ductus, both modalities are associated with significant adverse effects. Because the ductus does undergo spontaneous closure in some premature infants, improved and early identification of infants most likely to develop a symptomatic PDA could help in directing treatment to the at-risk infants and allow others to receive expectant management.
