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Updated: Sep 30, 2025

Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
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Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography

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Management of the patent ductus arteriosus in preterm infants

Souvik Mitra1, Dany Weisz1, Amish Jain1

  • 1Canadian Paediatric Society, Fetus and Newborn Committee, Drug Therapy and Hazardous Substances Committee, Ottawa, Ontario, Canada.

Paediatrics & Child Health
|March 11, 2022
PubMed

Insights

Patent ductus arteriosus (PDA) management in preterm infants involves prophylactic or symptomatic therapy. Ibuprofen is the preferred pharmacotherapy for symptomatic PDA, with procedural closure as a fallback if medical treatment fails.

Area of Science:

  • Neonatalogy
  • Pediatric Cardiology
  • Perinatal Medicine

Background:

  • Patent ductus arteriosus (PDA) management in preterm infants remains a complex and debated issue.
  • PDA can lead to significant complications, impacting infant health and requiring careful therapeutic strategies.

Purpose of the Study:

  • To outline current strategies for managing PDA in preterm infants.
  • To provide guidance on the use of echocardiography and therapeutic interventions for PDA.

Main Methods:

  • Review of prophylactic and symptomatic therapies for PDA.
  • Emphasis on echocardiography for diagnosis and assessment of PDA severity.
  • Discussion of pharmacotherapy (ibuprofen) and procedural closure options.

Main Results:

  • Prophylaxis with intravenous indomethacin may reduce severe intraventricular hemorrhage in extremely low birth weight infants.
  • Echocardiography is crucial for confirming PDA before symptomatic treatment.
  • Ibuprofen is the recommended pharmacotherapy for symptomatic PDA, with high-dose regimens potentially beneficial after the first few days of life.

Conclusions:

  • Symptomatic PDA management includes conservative approaches, pharmacotherapy (preferably ibuprofen), or procedural closure.
  • Procedural closure is indicated for persistent PDA with significant clinical symptoms and echocardiographic evidence of large shunt volume and pulmonary over-circulation when pharmacotherapy fails or is contraindicated.

Keywords:
Cyclo-oxygenase inhibitors (COX-I)Hemodynamically significant (hs)-PDAPatent ductus arteriosusPreterm infantsProcedural PDA closure

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