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Updated: Apr 25, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Natural evolution of patent ductus arteriosus in the extremely preterm infant
Audrey Rolland1, Shivani Shankar-Aguilera2, Douty Diomandé2
1Neonatal Intensive Care Unit, CHI Poissy Saint-Germain-en-Laye, Poissy, France Neonatal Intensive Care Unit, Hôpital Antoine-Béclère, Clamart, France.
Insights
Patent ductus arteriosus (PDA) often affects very preterm infants. This study found that PDA closes spontaneously in most infants born before 28 weeks, questioning the need for interventions.
Area of Science:
- Neonatalogy
- Pediatric Cardiology
Background:
- Patent ductus arteriosus (PDA) is common in very preterm infants.
- Current treatments for PDA do not consistently improve infant outcomes.
- Optimal PDA management strategies remain debated.
Purpose of the Study:
- To determine the rate of spontaneous PDA closure in infants born before 28 weeks of gestation.
- To evaluate the natural course of PDA in this vulnerable population.
Main Methods:
- Retrospective cohort study of 103 infants (gestational age 24-27 weeks).
- PDA defined as persistent ductal patency after 72 hours.
- Follow-up via regular echocardiography.
Main Results:
- Of 91 analyzed infants, 59 (65%) experienced spontaneous PDA closure.
- Spontaneous closure was observed in 73% of infants with persistent PDA after 72 hours.
- 11 infants died, and 7 were discharged before PDA closure could be determined.
Conclusions:
- A significant majority of very preterm infants experience spontaneous PDA closure.
- The risks associated with therapeutic interventions for PDA may outweigh the benefits.
- Further research is needed to refine management guidelines for PDA in extremely preterm neonates.
Objective:
The persistence of the patent ductus arteriosus (PDA) is frequently encountered in very preterm infants. Neither preventive nor curative treatments of PDA have been shown to improve the outcome of these infants. Since no consensus on optimal treatment of PDA is established, we evaluated the rate of spontaneous PDA closure in infants born before 28 weeks of gestation.
Patients And Methods:
We studied a retrospective cohort of 103 infants (gestational age 24-27 weeks) admitted to our neonatal intensive care unit from 1 June 2008 to 31 July 2010. Maternal and neonatal characteristics were collected. The PDA was defined by the persistence of ductal patency after 72 h and was followed up by regular echocardiography.
Results:
Twelve infants died within the first 72 h and were excluded from the analysis. Among 91 infants analysed, 8 (9%) closed their ductus arteriosus before 72 h and the ductus could not be determined patent in 13. Of the 70 infants with a PDA still persistent, one underwent surgical ligation and echocardiography showed spontaneous closure in 51 (73%) of them. In the remaining 18 infants, the date of PDA closure could not be determined either because of their death (n=11) or due to discharge (n=7). Overall, a spontaneous closure of the ductus arteriosus was observed in 59 of the 91 infants.
Conclusions:
We have to question whether exposure to the risks of therapeutic interventions targeted for ductal closure is warranted since a PDA closes spontaneously in at least 73% of infants born before 28 weeks.
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