Related Experiment Video
Updated: Dec 6, 2025
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Spontaneous Closure of the Ductus Arteriosus in Preterm Infants: A Systematic Review
Johan C A de Klerk1, Aline G J Engbers1,2, Floor van Beek1
1Division of Neonatology, Department of Pediatrics, Erasmus UMC-Sophia Children's Hospital, Rotterdam, Netherlands.
Insights
Patent ductus arteriosus (PDA) in preterm infants often closes spontaneously, especially with delayed treatment. Monitoring individual infants can optimize PDA management strategies.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Perinatology
Background:
- The optimal management of patent ductus arteriosus (PDA) in preterm infants is debated.
- Evidence may be biased by spontaneous closure rates dependent on infant characteristics.
- Delayed spontaneous closure is observed in preterm infants.
Approach:
- Systematic review of existing literature on PDA studies.
- Collected patient characteristics and spontaneous closure data.
- Analyzed spontaneous closure rates based on gestational age and birth weight.
Key Points:
- Spontaneous closure rates varied significantly.
- Lowest closure rates (34% day 4, 41% day 7) were in infants <28 weeks GA or <1000g birth weight.
- Higher closure rates (up to 55% day 3, 78% day 7) were in infants with higher GA or birth weight.
- Spontaneous closure probability increases up to at least 1 week post-birth.
Conclusions:
- Spontaneous closure of PDA increases up to at least 1 week post-birth.
- Delayed treatment for infants not showing spontaneous closure is favored.
- Predicting individual spontaneous closure is key for optimal PDA management in preterm infants.
Abstract:
The optimal management strategy for patent ductus arteriosus in preterm infants remains a topic of debate. Available evidence for a treatment strategy might be biased by the delayed spontaneous closure of the ductus arteriosus in preterm infants, which appears to depend on patient characteristics. We performed a systematic review of all literature on PDA studies to collect patient characteristics and reported numbers of patients with a ductus arteriosus and spontaneous closure. Spontaneous closure rates showed a high variability but were lowest in studies that only included preterm infants with gestational ages below 28 weeks or birth weights below 1,000 g (34% on day 4; 41% on day 7) compared to studies that also included infants with higher gestational ages or higher birth weights (up to 55% on day 3 and 78% on day 7). The probability of spontaneous closure of the ductus arteriosus keeps increasing until at least 1 week after birth which favors delayed treatment of only those infants that do not show spontaneous closure. Better prediction of the spontaneous closure of the ductus arteriosus in the individual newborn is a key factor to find the optimal management strategy for PDA in preterm infants.
