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Patent ductus arteriosus and oxidative stress in preterm infants: a narrative review
Carlo Dani1,2, Simone Pratesi2
1Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
Insights
Reactive oxygen species (ROS) and isoprostanes (IsoPs) aid patent ductus arteriosus (PDA) closure. However, significant PDA can cause oxidative stress, linking it to other preterm complications. Understanding this relationship is vital for clinical practice.
Area of Science:
- Neonatal physiology
- Cardiovascular research
- Oxidative stress mechanisms
Background:
- The patent ductus arteriosus (PDA) is a common complication in preterm infants.
- The roles of oxygen, reactive oxygen species (ROS), and isoprostanes (IsoPs) in PDA regulation are not fully understood.
- Oxidative stress is implicated in various preterm morbidities.
Purpose of the Study:
- To investigate the role of ROS and IsoPs in PDA patency and closure.
- To explore the correlation between hemodynamically significant PDA (hsPDA) and oxidative stress.
- To examine the impact of pharmacological PDA treatment on oxidative stress.
Main Methods:
- Systematic literature review of the MEDLINE database without time limits.
- Analysis of existing data on ROS, IsoPs, and PDA.
- Investigation of the relationship between hsPDA, oxidative stress, and prematurity complications.
Main Results:
- ROS and IsoPs are crucial for ductus arteriosus (DA) closure, not solely detrimental.
- hsPDA can induce systemic oxidative stress, contributing to complications like bronchopulmonary dysplasia (BPD), intraventricular haemorrhage (IVH), and necrotizing enterocolitis (NEC).
- Pharmacological agents like ibuprofen possess antioxidant properties, and PDA closure can normalize tissue oxygenation and redox balance.
Conclusions:
- A significant link exists between PDA and oxidative stress, impacting preterm infant outcomes.
- Understanding the interplay between PDA and oxidative stress enhances clinical management of this common prematurity complication.
- Further research is warranted to evaluate ROS as potential biomarkers for hsPDA risk.
Abstract:
The role of oxygen, reactive oxygen species (ROS), and isoprostanes (IsoPs) in regulating patency and closure of patent ductus arteriosus (PDA) have been studied in preterm infants. Also the possible correlation between a hemodynamically significant PDA and its pharmacological treatment with oxidative stress has been investigated. The National Library of Medicine (MEDLINE) database was searched without time limits. Available data demonstrate that free radicals are not always harmful and that ROS and IsoPs play a relevant role in DA closure. On the other hand, a hemodynamically significant PDA can cause oxidative stress and this can partially explain its association with other complications of prematurity related to oxidative stress, such as bronchopulmonary dysplasia (BPD), intraventricular haemorrhage (IVH), and necrotizing enterocolitis (NEC). Some drugs used for pharmacological closure, such as ibuprofen, also have antioxidant effects, and the closure of PDA can restore a proper tissue oxygenation and the balance between pro-oxidant and antioxidant factors. These data support the importance of the relationship between PDA and oxidative stress whose understanding increase our awareness when we approach this prematurity complication in the clinical practice. Further studies might assess the reliability of ROS as possible biomarkers of the risk of developing a hsPDA.
