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Published on: January 27, 2023
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Patent Ductus Arteriosus in Preterm Infants
Namasivayam Ambalavanan1, Susan W Aucott2, Arash Salavitabar3
1University of Alabama at Birmingham, Birmingham, Alabama.
Pediatrics
|April 27, 2025
Summary
Uncertainty persists regarding patent ductus arteriosus (PDA) in preterm infants. Current evidence does not support early medical closure, and long-term outcomes for later interventions remain undefined.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Clinical Evidence Synthesis
Background:
- Patent ductus arteriosus (PDA) remains a controversial topic in preterm infants, despite extensive research.
- Delayed ductal closure is common, especially in extremely premature infants, leading to varied clinical practices.
Purpose of the Study:
- To review evidence guiding the evaluation and treatment of preterm infants with prolonged ductal patency.
- To address the persistent uncertainty surrounding the significance, assessment, and management of PDA in this population.
Main Methods:
- Systematic review of existing clinical evidence and trial data.
- Echocardiography is highlighted as essential for PDA diagnosis and hemodynamic assessment.
Main Results:
- Prophylactic or early (<2 weeks) medical closure of PDA shows no benefit over expectant management and is not recommended.
- Evidence is insufficient for guiding management of hemodynamically significant PDA (hsPDA) beyond 2 weeks of age.
Conclusions:
- Management of hsPDA beyond 2 weeks requires further research, with equipoise regarding expectant management, pharmacologic closure, or procedural intervention.
- Transcatheter closure is becoming more common than surgical ligation for persistent hsPDA.
- More trials are needed to define optimal timing and long-term outcomes of PDA interventions.
