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Patent Ductus Arteriosus in the Preterm Infant: Diagnostic and Treatment Options
Stephanie Prescott1, Jessica Keim-Malpass
1University of Virginia School of Nursing, Charlottesville (Ms Prescott and Dr Keim-Malpass); and Fairfax Neonatal Associates, Inova Children's Hospital, Fairfax, Virginia (Ms Prescott).
Insights
The study reviews evidence on hemodynamically significant patent ductus arteriosus (hsPDA) in premature infants. Early treatment is debated, with oral ibuprofen showing promise, but consensus on diagnosis and management remains elusive.
Area of Science:
- Neonatal medicine
- Pediatric cardiology
- Perinatal research
Background:
- Hemodynamically significant patent ductus arteriosus (hsPDA) is common in premature infants and linked to morbidities.
- Current controversies exist regarding hsPDA definition, treatment indications, timing, methods, and outcomes.
Purpose of the Study:
- To review diagnostic and treatment recommendations for hsPDA based on the highest levels of evidence.
- To address the lack of consensus in hsPDA management.
Main Methods:
- Integrative literature review using PubMed and CINAHL.
- Keywords: "neonatal" and "patent ductus arteriosus".
Main Results:
- Lack of consensus on hsPDA diagnosis and significance impedes meta-analysis and management understanding.
- Emerging options include novel biomarkers, pharmaceuticals, and transcatheter closure.
Conclusions:
- Infants <1000g are at highest risk; prophylactic closure is not recommended.
- Early asymptomatic therapy is debated; conservative measures are often ineffective or detrimental.
- Cyclooxygenase inhibitors are effective but have side effects; oral ibuprofen shows lower necrotizing enterocolitis rates.
Background:
The incidence of hemodynamically significant patent ductus arteriosus (hsPDA) increases with decreasing gestational age and is associated with many common morbidities of extreme prematurity. Controversies remain surrounding the definition of hsPDA, the population of infants requiring treatment, the appropriate timing and method of treatment, and the outcomes associated with PDA and its therapies.
Purpose:
This integrative literature review focuses on diagnostic and treatment recommendations derived from the highest levels of evidence.
Search Strategy:
PubMed and CINAHL were searched using key words "neonatal" and "patent ductus arteriosus" to discover the highest levels of evidence surrounding diagnosis, treatment methods, and outcomes.
Findings/Results:
The lack of consensus surrounding the diagnosis and clinical significance of PDA hinders meta-analysis across studies and confounds understanding of appropriate management strategies. Novel biomarkers, pharmaceutical choices, and transcatheter closure methods are expanding diagnostic and treatment options.
Implications For Practice:
Infants weighing less than 1000 g are at highest risk. Prophylactic closure is no longer recommended, although early asymptomatic therapy is still preferred by some to avoid prolonged pulmonary overcirculation or decreased renal and gut perfusion. Conservative treatment measures such as fluid restriction and diuretic administration have not consistently proven effective and are in some instances detrimental. Cyclooxygenase inhibitors are effective but have adverse renal and mesenteric effects. Oral ibuprofen is associated with lower instance of necrotizing enterocolitis.
Implications For Research:
Well-defined staging criteria would aid in comparison and meta-analysis. Trials that include a control group that receives no therapy may help separate the outcomes associated with prematurity from those associated with PDA.
