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Patent ductus arteriosus in preterm infants: is early transcatheter closure a paradigm shift?
P Vali1, S Lakshminrusimha2, A Pelech2
1Department of Pediatrics, University of California Davis, Sacramento, CA, USA. pvali@ucdavis.edu.
Insights
The best way to manage patent ductus arteriosus (PDA) in premature babies is still unclear. Transcatheter PDA closure (TCPC) shows promise, but more research is needed to confirm its long-term benefits and safety.
Area of Science:
- Neonatal medicine
- Pediatric cardiology
- Interventional cardiology
Background:
- Management of patent ductus arteriosus (PDA) in premature infants lacks definitive evidence for long-term outcomes.
- Current medical and surgical interventions for PDA have limited analyses of their complications.
- Recent advancements include devices for transcatheter PDA closure (TCPC) in premature infants, including extremely low birthweight (<1000 g).
Purpose of the Study:
- To evaluate the potential of transcatheter PDA closure (TCPC) as a paradigm shift in managing PDA in premature infants.
- To assess whether TCPC improves short- and long-term outcomes, including bronchopulmonary dysplasia, neurodevelopment, and renal function.
- To determine the need for rigorous, adequately powered trials before widespread adoption of TCPC.
Main Methods:
- Review of recent trials demonstrating successful and safe transcatheter PDA closure (TCPC) in premature infants.
- Analysis of existing data on complications associated with medical and surgical PDA interventions.
- Emphasis on the need for well-designed, adequately powered studies.
Main Results:
- Several trials indicate that transcatheter PDA closure (TCPC) is feasible and safe in premature infants.
- Evidence regarding the long-term benefits and comparative effectiveness of TCPC versus other methods is still limited.
- Complications of traditional PDA management strategies require further detailed analysis.
Conclusions:
- Transcatheter PDA closure (TCPC) is a developing option for premature infants with PDA.
- Further rigorous investigation is essential to establish the long-term advantages and safety profile of TCPC.
- Widespread adoption of TCPC should be preceded by comprehensive, high-quality clinical trials.
Abstract:
The optimal management approach of the patent ductus arteriosus (PDA) in premature infants remains uncertain owing the lack of evidence for long-term benefits and the limited analyses of the complications of medical and surgical interventions to date. In recent years, devices suitable to plug the PDA of premature infants (including extremely low birthweight, <1000 g) have become available and several trials have demonstrated successful and safe transcatheter PDA closure (TCPC) in this population. Whether TCPC represents a paradigm shift in PDA management that will result in improved short- and long-term outcomes, less bronchopulmonary dysplasia, improved neurodevelopment, or better long term renal function remains to be seen. Careful rigorous study of the potential benefits of TCPC in this highly vulnerable population in the context of well-designed adequately powered trials is needed prior to widespread adoption of this approach.
