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Patent ductus arteriosus (PDA) and pulmonary morbidity: can early targeted pharmacologic PDA treatment decrease the

Ronald I Clyman1, Nancy K Hills2

  • 1Departments of Pediatrics and the Cardiovascular Research Institute, Emeritus, Pediatrics, University of California San Francisco, 513 Parnassus Ave, San Francisco, CA 94143-0734, United States.

Seminars in Perinatology
|March 7, 2023
PubMed

Insights

Persistent patent ductus arteriosus (PDA) in infants requiring prolonged ventilation increases bronchopulmonary dysplasia (BPD) risk. However, early pharmacologic PDA treatment does not seem to reduce BPD incidence in human infants.

Area of Science:

  • Neonatal physiology
  • Respiratory medicine
  • Pediatric cardiology

Background:

  • A persistent patent ductus arteriosus (PDA) shunt can lead to pulmonary complications and prolonged respiratory support needs in infants.
  • Infants with moderate/large PDA shunts requiring prolonged invasive ventilation (>10 days) face an elevated risk of developing bronchopulmonary dysplasia (BPD).

Purpose of the Study:

  • To evaluate the impact of persistent PDA on BPD development in infants requiring invasive ventilation.
  • To assess the effectiveness of early pharmacologic PDA closure in preventing BPD.

Main Methods:

  • Analysis of infants with persistent PDA and varying durations of invasive ventilation.
  • Review of randomized controlled trials and quality improvement projects on pharmacologic PDA treatment.

Main Results:

  • BPD risk is elevated in infants with PDA shunts lasting >7-14 days *and* requiring invasive ventilation for >10 days.
  • In contrast, infants ventilated for <10 days show similar BPD rates regardless of PDA shunt duration.
  • Current routine early pharmacologic PDA treatments do not appear to alter BPD incidence in human infants.

Conclusions:

  • The duration of invasive ventilation, in conjunction with PDA persistence, is a critical factor for BPD development.
  • Early targeted pharmacologic PDA closure strategies may not be effective in reducing BPD incidence in human infants.
  • Further research is needed to identify optimal management strategies for PDA in at-risk infant populations.

Keywords:
Bronchopulmonary dysplasiaDuctus arteriosusIntraventricular hemorrhageNewborn

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