Patent ductus arteriosus in premature neonates

Olachi J. Mezu-Ndubuisi, Ghanshyam Agarwal, Aarti Raghavan, Jennifer T. Pham, Kirsten H. Ohler, Akhil Maheshwari

Research output: Contribution to journalReview articlepeer-review

Abstract

Persistent patency of the ductus arteriosus is a major cause of morbidity and mortality in premature infants. In infants born prior to 28 weeks of gestation, a haemodynamically significant patent ductus arteriosus (PDA) can cause cardiovascular instability, exacerbate respiratory distress syndrome, prolong the need for assisted ventilation and increase the risk of bronchopulmonary dysplasia, intraventricular haemorrhage, renal dysfunction, cerebral palsy and mortality. We review the pathophysiology, clinical features and assessment of haemodynamic significance, and provide a rigorous appraisal of the quality of evidence to support current medical and surgical management of PDA of prematurity. Cyclo-oxygenase inhibitors such as indomethacin and ibuprofen remain the mainstay of medical therapy for PDA, and can be used both for prophylaxis as well as for rescue therapy to achieve PDA closure. Surgical ligation is also effective and is used in infants who do not respond to medical management. Although both medical and surgical treatment have proven efficacy in closing the ductus, both modalities are associated with significant adverse effects. Because the ductus does undergo spontaneous closure in some premature infants, improved and early identification of infants most likely to develop a symptomatic PDA could help in directing treatment to the at-risk infants and allow others to receive expectant management.

Original languageEnglish (US)
Pages (from-to)907-916
Number of pages10
JournalDrugs
Volume72
Issue number7
DOIs
StatePublished - 2012
Externally publishedYes

Keywords

  • Congestive-heart-failure
  • Ductus-arteriosus
  • Ibuprofen
  • Indometacin
  • Neonates.

ASJC Scopus subject areas

  • Pharmacology (medical)

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