Spontaneous Closure of the Ductus Arteriosus in Preterm Infants: A Systematic Review

Abstract

The optimal management strategy for patent ductus arteriosus in preterm infants remains a topic of debate. Available evidence for a treatment strategy might be biased by the delayed spontaneous closure of the ductus arteriosus in preterm infants, which appears to depend on patient characteristics. We performed a systematic review of all literature on PDA studies to collect patient characteristics and reported numbers of patients with a ductus arteriosus and spontaneous closure. Spontaneous closure rates showed a high variability but were lowest in studies that only included preterm infants with gestational ages below 28 weeks or birth weights below 1,000 g (34% on day 4; 41% on day 7) compared to studies that also included infants with higher gestational ages or higher birth weights (up to 55% on day 3 and 78% on day 7). The probability of spontaneous closure of the ductus arteriosus keeps increasing until at least 1 week after birth which favors delayed treatment of only those infants that do not show spontaneous closure. Better prediction of the spontaneous closure of the ductus arteriosus in the individual newborn is a key factor to find the optimal management strategy for PDA in preterm infants.

Keywords: ELBW; VLBW; patent ductus arteriosus; preterm infants; spontaneous closure; systematic review.

Figure 1

Flow diagram of the studies retrieved for this review.

Figure 2

Reported percentages of closure of patent ductus arteriosus of all included studies, up to a postnatal age of 28 days. Each dot represents a reported percentage, whose size represents the square root of the total number of patients of that observation.

Figure 3

Reported percentages of patients with patent ductus arteriosus up to a postnatal age of 4 days, grouped by mean or median gestational age or birthweight if gestational age was unreported. Each dot represents one observation at the reported postnatal age. The size of the dots represents square root of the number of patients of each observation. Lines represent a linear smooth weighted by the number of patients of each observation.

Figure 4

Reported percentages of patients with patent ductus arteriosus up to a postnatal age of 8 days, grouped by mean or median gestational age or birthweight if gestational age was unreported. Each dot represents one observation at the reported postnatal age. The size of the dots represents square root of the number of patients of each observation. Lines represent a linear smooth weighted by the number of patients of each observation.