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Management strategies for the preemie ductus
Amir H Ashrafi1, Victor Y Levy2
1Division of Neonatology, CHOC Children's Hospital, Orange, California.
Current Opinion in Cardiology
|November 6, 2018
Summary
Patent ductus arteriosus (PDA) in neonates is common, but treatment decisions remain unclear. Current evidence suggests watchful waiting may be preferable to indiscriminate closure due to risks associated with intervention.
Area of Science:
- Neonatal cardiology
- Pediatric cardiovascular research
- Perinatal medicine
Background:
- Patent ductus arteriosus (PDA) is the most prevalent cardiovascular condition in neonates.
- Despite extensive research, optimal treatment strategies for neonatal PDA remain debated.
- Historically, most PDAs were treated soon after birth, often without clear evidence of hemodynamic significance.
Purpose of the Study:
- To review the scientific literature on neonatal PDA pathophysiology, genetics, and treatment.
- To address contemporary biases in the management of PDA.
- To clarify which PDAs require intervention.
Main Methods:
- Literature review of scientific studies on neonatal PDA.
- Analysis of echocardiographic, biochemical, and clinical data for shunt assessment.
- Evaluation of epidemiological data linking PDA to morbidities.
Main Results:
- No randomized trials demonstrate significant benefits of PDA closure over no intervention.
- Surgical ligation of PDA is associated with increased morbidities and adverse neurodevelopmental outcomes.
- Clinical assessment and diagnostic tools can indicate shunt magnitude and physiologic impact.
Conclusions:
- A strategy of watchful waiting is increasingly favored for neonatal PDA management.
- Indiscriminate PDA closure lacks robust evidence of benefit and carries risks.
- Further research is needed to refine treatment decisions for neonatal PDA.
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