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

Kimberly Fernandez Trahan1, Elaine L Shelton1, Maria Gillam-Krakauer1

  • 1Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, 2200 Children's Way, DOT, 11111, Nashville, TN 37232 USA.

Current Treatment Options in Cardiovascular Medicine
|July 25, 2025
PubMed

Insights

Standardizing patent ductus arteriosus (PDA) treatment requires addressing knowledge gaps. Recent advancements like targeted neonatal echocardiography (TnECHO) and new therapies show promise for individualized infant care.

Area of Science:

  • Neonatal Cardiology
  • Pediatric Pharmacology
  • Medical Technology

Background:

  • Patent ductus arteriosus (PDA) treatment lacks standardization due to varied definitions of hemodynamic significance (hsPDA) and limited long-term outcome data.
  • Discrepancies in management approaches persist, impacting clinical decision-making for neonates.

Purpose of the Study:

  • To review current PDA treatment strategies in the neonatal period.
  • To identify knowledge gaps hindering standardization and discuss recent advancements.
  • To explore future directions for targeted and individualized PDA management.

Main Methods:

  • Review of recent clinical trials and literature on PDA management.
  • Analysis of emerging diagnostic tools like targeted neonatal echocardiography (TnECHO).
  • Evaluation of pharmacological (e.g., acetaminophen) and non-pharmacological interventions.

Main Results:

  • Early versus expectant management of PDA has not shown improved outcomes in recent trials.
  • TnECHO facilitates timely interventions with positive outcomes.
  • Acetaminophen use is increasing, even in very preterm infants (<24 weeks).
  • Advancements include percutaneous transcatheter occlusion and understanding ductal gene expression.

Conclusions:

  • Targeted, individualized PDA treatment is becoming achievable with increased TnECHO use, clarified transcatheter closure scope, and better understanding of ductal genetics.
  • Further research into genetic/molecular factors and medication/fluid balance effects is crucial.
  • Development of innovative therapies to promote ductal closure remains a necessity.
Abstract

Keywords:
AcetaminophenBronchopulmonary dysplasiaExtreme prematurityPatent ductus arteriosusTranscatheter ductus closure

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