Patent Ductus Arteriosus in Extremely Preterm Infants: Update on Current Diagnostic and Treatment Options

Patent ductus arteriosus (PDA) treatment strategies in the neonatal period differ widely. Variations in what constitutes hemodynamic significance (hsPDA) and scarcity of high-quality data on long-term outcomes has contributed to lack of standardization. Filling these knowledge gaps would impact clinical decision making.

Recent trials have not shown improvement in outcomes with early compared to expectant management. Targeted neonatal echocardiography (TnECHO) has facilitated timely intervention with encouraging outcomes. Acetaminophen use is increasing even in infants < 24 weeks. Advancements in percutaneous transcatheter occlusion, characterization of the unique expression of genes and ion channels of the ductus arteriosus, and attention to nonpharmacologic strategies are essential advances in PDA management.

With increased utilization of TnECHO, clarification of the scope of transcatheter-based closures, further understanding of the genetic and molecular factors involved in ductal tone, and the appreciation of the off-target effects that medications and fluid balance can have on the DA, providing targeted, individualized PDA treatment is achievable. However, the development of innovative therapies to promote ductal closure is a necessity.