Personalized Evidence-Based Management of Patent Ductus Arteriosus in Preterm Infants

Abstract

There is no universal consensus on management of patent ductus arteriosus (PDA) in preterm infants and it varies significantly worldwide, even among the clinicians within units. The decision to treat requires a thorough understanding of the clinical status of the patient, clinical evaluation of PDA, echocardiographic diagnosis, and hemodynamic impact of ductal shunt on the pulmonary and systemic circulation. In this article, updated evidence on the efficacy and adverse effects of pharmacological treatment options and expectant management are presented, while highlighting the long-term benefits of PDA treatment remains equivocal and controversial. The authors propose a schematic targeted PDA treatment approach based on gestational and chronological age for practical clinical use, and they emphasize important future directions including advancement in PDA device closure techniques, diagnostic echo-parameters, hemodynamic evaluation to assess the impact on other organs, and understanding the long-term outcomes.

Keywords: ibuprofen; indomethacin; medical treatment; patent ductus arteriosus (PDA); premature infant; preterm infant.

Figure 1

Arachidonic acid metabolism pathway.

Figure 2

PDA medical management strategy (adapted from ¹ Semberova 2017 [17], ² Sheppahrd 2018 (https://www.eyeonprivacy.com/2018/11/fda-issues-new-draft-cybersecurity-guidance-for-medical-devices/ (Accessed date 1 November 2023)) and ³ Hamrick 2020 [1]).