Patent ductus arteriosus in preterm infant: review of diagnosis and management
Keywords:patent ductus arteriosus, preterm, diagnosis, management
The management of preterm newborns (PN) has shown an extraordinary improvement in the last decades. The patent ductus arteriosus (PDA) is a common complication associated with prematurity.
Over the last 50 years, since Powell described the first report of ductal closure in preterm infant (1963), the best therapeutic approach is still controversial.
The studies in the 1980s and 1990s demonstrated the pathophysiology, clinical signs, diagnosis and closure of PDA with indomethacin or surgery. In the 2000s, the researches focused in new agents to closure PDA. Currently, the functional echocardiography is emerging as an important tool for early diagnosis of hemodynamically significant ductus and has been used for early targeted treatment of ductus arteriosus. The current management of PDA in PN includes the conservative management for neonates with more than 30 weeks of gestational age (GA) and PDA without clinical repercussion, and pharmacologic closure using cyclooxygenase inhibitors or surgical procedure for those with less than 30 weeks of GA and hemodynamic signiÞ cant ductus arteriosus (HSDA).
It remains unclear which approach is better. The clinical signs, symptoms and morbidities can be found in preterm infants with or without PDA, especially in those extremely premature less than 30 weeks.
The objective of this review is to discuss the pathophysiology, diagnosis and current management of patent ductus arteriosus in preterm infant.
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