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Published on: January 27, 2023
[Management of patent ductus arteriosus in preterm infants: An evidence-based approach]
1Service de cardiologie pédiatrique, hôpital de la mère et de l'enfant, 7, quai Moncousu, 44000 Nantes, France.
Insights
Patent ductus arteriosus (PDA) in preterm infants causes serious complications and is controversial to manage. Current trends favor personalized treatment strategies based on individual infant factors.
Area of Science:
- Neonatalogy
- Pediatric Cardiology
- Perinatology
Background:
- Patent ductus arteriosus (PDA) is highly prevalent in preterm infants (<28 weeks gestation), affecting up to 70%.
- PDA causes left-to-right shunting, leading to pulmonary circulation overload and reduced systemic blood flow.
- These hemodynamic changes increase risks for respiratory, neurological, and digestive issues, alongside higher mortality.
Purpose of the Study:
- To review current knowledge on PDA pathophysiology and closure mechanisms.
- To describe various treatment modalities, their benefits, and side effects.
- To discuss therapeutic strategies evaluated over the past four decades.
Main Methods:
- Comprehensive review of literature on patent ductus arteriosus management in preterm infants.
- Analysis of therapeutic interventions, their outcomes, and associated risks.
- Synthesis of evidence to inform current management trends.
Main Results:
- Despite advances, PDA management in preterm infants remains a significant clinical controversy.
- Diverse treatment options exist, each with specific benefits and potential adverse effects.
- Historical data reveals evolving therapeutic strategies over 40 years.
Conclusions:
- A personalized approach to PDA management is the current trend.
- Treatment should be tailored to each preterm infant's unique characteristics and risk factors.
- Individualized care aims to optimize outcomes for preterm infants with PDA.
Abstract:
A patent ductus arteriosus, very common in the preterm infant (incidence up to 70% in infants less than 28 weeks gestational age), causes a left-to-right shunt leading to overload of the pulmonary circulation and low systemic blood flow. These hemodynamic anomalies are associated with a higher incidence of respiratory, neurological, and digestive complications of prematurity, as well as a higher mortality rate. Although growing knowledge about the natural history, the pathophysiology, and the mechanisms of closure of the ductus arteriosus has resulted in therapeutic progress, management of the patent ductus arteriosus in the preterm infant is still a subject of intense controversy. We describe here the different treatment modalities, their benefits and side effects, and the therapeutic strategies that have been tested in the last four decades. Based on this evidence, the current trend is a personalized approach to the patent ductus arteriosus, adapted to each preterm infant's individual characteristics and risk factors.
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