Related Experiment Video
Updated: Jun 17, 2025
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
A Global Perspective on PDA Management in the Extremely Premature: Shifting Trend Toward Transcatheter Closure
Shyam Sathanandam1, Patrick McNamara2, Carlos Pedra3
1LeBonheur Children's Hospital, University of Tennessee, Memphis, Tennessee.
Insights
Patent ductus arteriosus (PDA) management is shifting towards selective treatment in extremely premature infants. Transcatheter patent ductus arteriosus closure (TCPC) is emerging as a viable option, prompting a review of global trends and outcomes.
Area of Science:
- Neonatal Cardiology
- Pediatric Cardiovascular Interventions
- Perinatal Medicine
Background:
- Patent ductus arteriosus (PDA) is common in extremely premature infants (≤26 weeks' gestation).
- Historical treatments (medications, surgery) lack demonstrated benefits in this population.
- Increased survival of premature infants has led to rising PDA-associated comorbidities.
Purpose of the Study:
- To review global trends in PDA management for premature infants.
- To examine the increasing adoption of transcatheter patent ductus arteriosus closure (TCPC).
- To provide a guide for pediatric cardiologists on PDA management options.
Main Methods:
- Comprehensive review of existing literature and landmark clinical trials.
- Compilation of data from international neonatal networks.
- Analysis of comparative outcomes and expert opinions globally.
Main Results:
- A shift from conservative management towards selective PDA treatment is observed.
- Transcatheter patent ductus arteriosus closure (TCPC) is gaining traction as an alternative therapy.
- Data highlights variations in management strategies and outcomes across different countries.
Conclusions:
- Understanding current PDA management and outcomes is crucial for offering TCPC.
- TCPC presents a potentially viable therapeutic option for extremely premature infants with PDA.
- Further global consensus is needed for optimal PDA management in this high-risk cohort.
Abstract:
Patent ductus arteriosus (PDA) is a frequently encountered defect in infants born extremely premature (≤26 weeks' gestation). Historically, closure of the PDA was performed using cyclooxygenase inhibitor medications or by surgical ligations. However, the benefits of PDA closure using these therapies have never been demonstrated, albeit studies have previously not focused on the extremely premature infants. Therefore, there was a worldwide trend toward conservative management of the PDA. With improved survival of extremely premature infants, comorbidities associated with the PDA has increased, resulting in finding alternate treatments such as transcatheter patent ductus arteriosus closure (TCPC) for this population. Currently, there is a renewed interest toward selective treatment of the PDA in this high-risk cohort of small infants. This Comprehensive Review article inspects the globally changing trends in the management of the PDA in premature infants, with a special focus on the rising adoption of TCPC. Moreover, this article compiles data from several neonatal networks worldwide to help understand the problem at hand. Understanding the current management of premature infants and their outcomes is fundamentally essential if pediatric cardiologists are to offer TCPC as a viable therapeutic option for this population. This article aims to serve as a guide for pediatric cardiologists on this topic by compiling the results on landmark clinical trials on PDA management and the controversies that arise from these trials. Comparative outcomes from several countries are presented, including interpretations and opinions of the data from experts globally. This is a step toward coming to a global consensus in PDA management in premature infants.
