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Abstract
Management of patent ductus arteriosus (PDA) in preterm infants has always been a challenge to the neonatologist and continues to be a controversial topic. There is no evidence that medical treatment with cyclooxygenase inhibitors for the prevention and treatment of PDA decreases mortality or serious morbidity, despite success in closure of the PDA. In practice, however, treatment decisions should be made for individual preterm infants in the absence of knowledge about benefits and risks of medical treatment should be made on the individual basis. This article attempts to review the current available, often conflicting data and to present the clinical guidelines for management of PDA in preterm infants, especially for extremely low birth weight (ELBW) infants. Prophylactic or early pre-symptomatic treatment may unnecessarily expose these infants, in whom the ductus might close spontaneously, to pharmacologic agents and their adverse effects. On the other hand, with advancing postnatal age, delayed treatment could potentially decrease successful medical closure thereby increasing the rate of surgical ligation and the complications associated with surgery. Therefore early symptomatic treatment in ELBW infants is preferred as the primary pharmacologic treatment for PDA. Conservative treatment with adjustment of ventilation and fluid restriction is beneficial as an alternative management to prophylactic pharmacologic treatment.
References
1. Agarwal R, Deorari AK, Paul VK. Patent ductus arteriosus in preterm neonates. Indian J Pediatr. 2008; 75:277–280.
2. Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR, Bauer CR, Donovan EF, Korones SB, Laptook AR, Lemons JA, Oh W, Papile LA, Shankaran S, Stevenson DK, Tyson JE, Poole WK. Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol. 2007; 196:147.e1–147.e8.
3. Lee SK, Mc Millan DD, Ohlsson A, Pendray M, Synnes A, Whyte R, Chien LY, Sale J. Variations in practice and outcomes in the Canadian NICU network: 1996-1997. Pediatrics. 2000; 106:1070–1079.
4. Koch J, Hensley G, Roy L, Brown S, Ramaciotti C, Rosenfeld CR. Prevalence of spontaneous closure of the ductus arteriosus in neonates at a birth weight of 1000 grams or less. Pediatrics. 2006; 117:1113–1121.
5. Narayanan M, Cooper B, Weiss H, Clyman RI. Prophylactic indomethacin: factors determining permanent ductus arteriosus closure. J Pediatr. 2000; 136:330–337.
6. Jacob J, Gluck L, DiSessa T, Edwards D, Kulovich M, Kurlinski J, Merritt TA, Friedman WF. The contribution of PDA in the neonate with severe RDS. J Pediatr. 1980; 96:79–87.
7. Furzan JA, Reisch J, Tyson JE, Laird P, Rosenfeld CR. Incidence and risk factors for symptomatic patent ductus arteriosus among inborn very-low-birth-weight infants. Early Hum Dev. 1985; 12:39–48.
8. Gonzalez A, Sosenko IR, Chandar J, Hummler H, Claure N, Bancalari E. Influence of infection on patent ductus arteriosus and chronic lung disease in premature infants weighing 1000 grams or less. J Pediatr. 1996; 128:470–478.
9. Bell EF, Warburton D, Stonestreet BS, Oh W. Effect of fluid administration on the development of symptomatic patent ductus arteriosus and congestive heart failure in premature infants. N Engl J Med. 1980; 302:598–604.
10. Martin CG, Snider AR, Katz SM, Peabody JL, Brady JP. Abnormal cerebral blood flow patterns in preterm infants with a large patent ductus arteriosus. J Pediatr. 1982; 101:587–593.
11. Perlman JM, Hill A, Volpe JJ. The effect of patent ductus arteriosus on flow velocity in the anterior cerebral arteries: ductal steal in the premature newborn infant. J Pediatr. 1981; 99:767–771.
12. Cassady G, Crouse DT, Kirklin JW, Strange MJ, Joiner CH, Godoy G, Odrezin GT, Cutter GR, Kirklin JK, Pacifico AD. A randomized, controlled trial of very early prophylactic ligation of the ductus arteriosus in babies who weighed 1000 g or less at birth. N Engl J Med. 1989; 320:1511–1516.
13. Rojas MA, Gonzalez A, Bancalari E, Claure N, Poole C, Silva-Neto G. Changing trends in the epidemiology and pathogenesis of neonatal chronic lung disease. J Pediatr. 1995; 126:605–610.
14. Chess PR, D'Angio CT, Pryhuber GS, Maniscalco WM. Pathogenesis of bronchopulmonary dysplasia. Semin Perinatol. 2006; 30:171–178.
15. Choi BM. Recent trend in management of neonatal patent ductus arteriosus. J Korean Pediatr Cardiol Soc. 2003; 7:177–184.
16. Choi BM. Patent ductus arteriosus in preterm infants. In : The 15th Annual Autumn Meeting of the Korean Society of Neonatology; Seoul, Korea: Korean Society of Neonatology;2008. p. 15–42.
17. Kim SM. Therapeutic Strategies for PDA in Prematurity (How to treat PDA? When to treat PDA?). J Korean Soc Neonatol. 2007; 14:142–152.
18. Hoellering AB, Cooke L. The management of patent ductus arteriosus in Australia and New Zealand. J Paediatr Child Health. 2009; 45:204–209.
19. Laughon M, Bose C, Clark R. Treatment strategies to prevent or close a patent ductus arteriosus in preterm infants and outcomes. J Perinatol. 2007; 27:164–170.
20. DiMenna L, Laabs C, McCoskey L, Seals A. Management of the neonate with patent ductus arteriosus. J Perinat Neonatal Nurs. 2006; 20:333–340. quiz 41-2.
21. Vanhaesebrouck S, Zonnenberg I, Vandervoort P, Bruneel E, Van Hoestenberghe MR, Theyskens C. Conservative treatment for patent ductus arteriosus in the preterm. Arch Dis Child Fetal Neonatal Ed. 2007; 92:F244–F247.
22. Brion LP, Campbell DE. Furosemide for symptomatic patent ductus arteriosus in indomethacin-treated infants. Cochrane Database Syst Rev. 2001; CD001148.
23. Andriessen P, Struis NC, Niemarkt H, Oetomo SB, Tanke RB, Van Overmeire B. Furosemide in preterm infants treated with indomethacin for patent ductus arteriosus. Acta Paediatr. 2009; 98:797–803.
24. Bouissou A, Rakza T, Klosowski S, Tourneux P, Vanderborght M, Storme L. Hypotension in preterm infants with significant patent ductus arteriosus: effects of dopamine. J Pediatr. 2008; 153:790–794.
25. Seri I, Abbasi S, Wood DC, Gerdes JS. Regional hemodynamic effects of dopamine in the indomethacin-treated preterm infant. J Perinatol. 2002; 22:300–305.
26. Fowlie PW, Davis PG. Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants. Cochrane Database Syst Rev. 2002; CD000174.
27. Ment LR, Oh W, Ehrenkranz RA, Philip AG, Vohr B, Allan W, Duncan CC, Scott DT, Taylor KJ, Katz KH, Schneider KC, Makuch RW. Low-dose indomethacin and prevention of intraventricular hemorrhage: a multicenter randomized trial. Pediatrics. 1994; 93:543–550.
28. Schmidt B, Davis P, Moddemann D, Ohlsson A, Roberts RS, Saigal S, Solimano A, Vincer M, Wright LL. Long-term effects of indomethacin prophylaxis in extremely-low-birth-weight infants. N Engl J Med. 2001; 344:1966–1972.
29. Vohr BR, Allan WC, Westerveld M, Schneider KC, Katz KH, Makuch RW, Ment LR. School-age outcomes of very low birth weight infants in the indomethacin intraventricular hemorrhage prevention trial. Pediatrics. 2003; 111:e340–e346.
30. Schmidt B, Roberts RS, Fanaroff A, Davis P, Kirpalani HM, Nwaesei C, Vincer M. Indomethacin prophylaxis, patent ductus arteriosus, and the risk of bronchopulmonary dysplasia: further analyses from the Trial of Indomethacin Prophylaxis in Preterms (TIPP). J Pediatr. 2006; 148:730–734.
31. Chiruvolu A, Jaleel MA. Therapeutic management of patent ductus arteriosus. Early Hum Dev. 2009; 85:151–155.
32. Bose CL, Laughon M. Treatment to prevent patency of the ductus arteriosus: beneficial or harmful? J Pediatr. 2006; 148:713–714.
33. Van Overmeire B, Van de Broek H, Van Laer P, Weyler J, Vanhaesebrouck P. Early versus late indomethacin treatment for patent ductus arteriosus in premature infants with respiratory distress syndrome. J Pediatr. 2001; 138:205–211.
34. Clyman RI. Patent ductus arteriosus in preterm neonates. In : Taeush HW, Ballard RA, editors. Avery's diseases of the newborn. 8th ed. WB Saunders;2005. p. 816–826.
35. Clyman RI. Recommendations for the postnatal use of indomethacin: an analysis of four separate treatment strategies. J Pediatr. 1996; 128:601–607.
36. Cooke L, Steer P, Woodgate P. Indomethacin for asymptomatic patent ductus arteriosus in preterm infants. Cochrane Database Syst Rev. 2003; CD003745.
37. Knight DB. The treatment of patent ductus arteriosus in preterm infants. A review and overview of randomized trials. Semin Neonatol. 2001; 6:63–73.
38. Mahony L, Carnero V, Brett C, Heymann MA, Clyman RI. Prophylactic indomethacin therapy for patent ductus arteriosus in very-low-birth-weight infants. N Engl J Med. 1982; 306:506–510.
39. Lee KS. Indomethacin therapy for patent ductus arteriosus in premature infants. Pediatr Cardiol. 2008; 29:873–875.
40. Kabra NS, Schmidt B, Roberts RS, Doyle LW, Papile L, Fanaroff A. Neurosensory impairment after surgical closure of patent ductus arteriosus in extremely low birth weight infants: results from the Trial of Indomethacin Prophylaxis in Preterms. J Pediatr. 2007; 150:229–234. 234.e1
41. Hermes-DeSantis ER, Clyman RI. Patent ductus arteriosus: pathophysiology and management. J Perinatol. 2006; 26:Suppl 1. S14–S18. discussion S22-3.
42. Thomas E, Young O. Neofax: A Manual of Drugs Used in Neonatal Care. Raleigh, NC: Acorn Publishing;2007.
43. Siassi B, Blanco C, Cabal LA, Coran AG. Incidence and clinical features of patent ductus arteriosus in low-birthweight infants: a prospective analysis of 150 consecutively born infants. Pediatrics. 1976; 57:347–351.
44. Gersony WM, Peckham GJ, Ellison RC, Miettinen OS, Nadas AS. Effects of indomethacin in premature infants with patent ductus arteriosus: results of a national collaborative study. J Pediatr. 1983; 102:895–906.
45. Dani C, Bertini G, Corsini I, Elia S, Vangi V, Pratesi S, Rubaltelli FF. The fate of ductus arteriosus in infants at 23-27 weeks of gestation: from spontaneous closure to ibuprofen resistance. Acta Paediatr. 2008; 97:1176–1180.
46. Boo NY, Mohd-Amin I, Bilkis AA, Yong-Junina F. Predictors of failed closure of patent ductus arteriosus with indomethacin. Singapore Med J. 2006; 47:763–768.
47. Quinn D, Cooper B, Clyman RI. Factors associated with permanent closure of the ductus arteriosus: a role for prolonged indomethacin therapy. Pediatrics. 2002; 110:e10.
48. Keller RL, Clyman RI. Persistent Doppler flow predicts lack of response to multiple courses of indomethacin in premature infants with recurrent patent ductus arteriosus. Pediatrics. 2003; 112:583–587.
49. Yang CZ, Lee J. Factors affecting successful closure of hemodynamically significant patent ductus arteriosus with indomethacin in extremely low birth weight infants. World J Pediatr. 2008; 4:91–96.
50. Sangem M, Asthana S, Amin S. Multiple courses of indomethacin and neonatal outcomes in premature infants. Pediatr Cardiol. 2008; 29:878–884.
51. Tammela O, Ojala R, Iivainen T, Lautamatti V, Pokela ML, Janas M, Koivisto M, Ikonen S. Short versus prolonged indomethacin therapy for patent ductus arteriosus in preterm infants. J Pediatr. 1999; 134:552–557.
52. Herrera C, Holberton J, Davis P. Prolonged versus short course of indomethacin for the treatment of patent ductus arteriosus in preterm infants. Cochrane Database Syst Rev. 2007; CD003480.
53. Ohlsson A, Walia R, Shah S. Ibuprofen for the treatment of patent ductus arteriosus in preterm and/or low birth weight infants. Cochrane Database Syst Rev. 2008; CD003481.
54. Gournay V, Savagner C, Thiriez G, Kuster A, Roze JC. Pulmonary hypertension after ibuprofen prophylaxis in very preterm infants. Lancet. 2002; 359:1486–1488.
55. Bellini C, Campone F, Serra G. Pulmonary hypertension following L-lysine ibuprofen therapy in a preterm infant with patent ductus arteriosus. CMAJ. 2006; 174:1843–1844.
56. Van Overmeire B, Allegaert K, Casaer A, Debauche C, Decaluwe W, Jespers A, Weyler J, Harrewijn I, Langhendries JP. Prophylactic ibuprofen in premature infants: a multicentre, randomised, double-blind, placebo-controlled trial. Lancet. 2004; 364:1945–1949.
57. Malviya M, Ohlsson A, Shah S. Surgical versus medical treatment with cyclooxygenase inhibitors for symptomatic patent ductus arteriosus in preterm infants. Cochrane Database Syst Rev. 2008; CD003951.
58. Chorne N, Leonard C, Piecuch R, Clyman RI. Patent ductus arteriosus and its treatment as risk factors for neonatal and neurodevelopmental morbidity. Pediatrics. 2007; 119:1165–1174.
59. Kabra NS, Schmidt B, Roberts RS, Doyle LW, Papile L, Fanaroff A, Pre TIP. Neurosensory impairment after surgical closure of patent ductus arteriosus in extremely low birth weight infants: Results from the trial of indomethacin prophylaxis in preterms. J Pediatr. 2007; 150:229–234.
60. Raval MV, Laughon MM, Bose CL, Phillips JD. Patent ductus arteriosus ligation in premature infants: who really benefits, and at what cost? J Pediatr Surg. 2007; 42:69–75. discussion 75.
61. Bose CL, Laughon MM. Patent ductus arteriosus: lack of evidence for common treatments. Arch Dis Child Fetal Neonatal Ed. 2007; 92:F498–F502.
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