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Published on: January 27, 2023
Personalized Evidence-Based Management of Patent Ductus Arteriosus in Preterm Infants
Belinda Chan1,2, Yogen Singh3,4
1Neonatology Division, Department of Pediatrics, University of Utah, Salt Lake City, UT 84113, USA.
Insights
Management of patent ductus arteriosus (PDA) in preterm infants lacks consensus. This review examines treatment options, highlighting the need for a targeted approach and further research into long-term outcomes.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
Background:
- Patent ductus arteriosus (PDA) management in preterm infants lacks universal consensus, leading to varied clinical practices globally.
- Decisions for PDA treatment require comprehensive assessment of patient status, clinical evaluation, echocardiography, and hemodynamic impact.
Purpose of the Study:
- To present updated evidence on the efficacy and adverse effects of pharmacological treatments and expectant management for PDA in preterm infants.
- To highlight the ongoing controversy and equivocal nature of long-term benefits associated with PDA treatment.
- To propose a practical, age-based targeted treatment approach for PDA and identify future research directions.
Main Methods:
- Review of updated evidence on pharmacological treatment options and expectant management for PDA.
- Analysis of diagnostic parameters, including echocardiography and hemodynamic evaluation.
- Development of a schematic, age-based targeted PDA treatment approach.
Main Results:
- Evidence on the efficacy and adverse effects of current PDA pharmacological treatments and expectant management is presented.
- Long-term benefits of PDA treatment remain equivocal and controversial.
- A targeted PDA treatment approach based on gestational and chronological age is proposed for clinical use.
Conclusions:
- A standardized, targeted approach to PDA management in preterm infants is needed.
- Further research is crucial for advancing PDA device closure techniques, diagnostic echocardiographic parameters, and hemodynamic evaluation.
- Understanding the long-term outcomes of PDA and its treatment is essential for optimizing infant care.
Abstract:
There is no universal consensus on management of patent ductus arteriosus (PDA) in preterm infants and it varies significantly worldwide, even among the clinicians within units. The decision to treat requires a thorough understanding of the clinical status of the patient, clinical evaluation of PDA, echocardiographic diagnosis, and hemodynamic impact of ductal shunt on the pulmonary and systemic circulation. In this article, updated evidence on the efficacy and adverse effects of pharmacological treatment options and expectant management are presented, while highlighting the long-term benefits of PDA treatment remains equivocal and controversial. The authors propose a schematic targeted PDA treatment approach based on gestational and chronological age for practical clinical use, and they emphasize important future directions including advancement in PDA device closure techniques, diagnostic echo-parameters, hemodynamic evaluation to assess the impact on other organs, and understanding the long-term outcomes.
