Abstract
Objective
Patent ductus arteriosus is very commonly seen in very low birth weight (VLBW) infants, affecting about one-third. The present review tries to identify the group of VLBW infants who need active intervention in day-to-day practice and to determine the mode of intervention, based on current published literatures.
Methods
We searched the Cochrane library, MEDLINE, EMBASE and CINAHL databases, and reference that of identified trials.
Results and Conclusions
Preterm infants with a birth weight of <800g are at risk of significant morbidity and mortality from PDA; it would be reasonable to treat them when symptomatic or if requiring positive pressure ventilator support. Those weighing >800g are unlikely to need treatment unless they are ventilator-dependent or show evidence of congestive heart failure.
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References
Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39:1890–1900.
Investigators of the Vermont Oxford Trials Network Database Project. The Vermont Oxford Trials Network: Very low birthweight outcomes for 1990. Pediatrics. 1993;91:540–545.
Alagarsamy S, Chhabra M, Gudavalli M, Nadroo AM, Sutija VG, Yugrakh D. Comparison of clinical criteria with echocardiographic findings in diagnosing PDA in preterm infants. J Perinat Med. 2005;33:161–164.
Sehgal A, McNamara PJ. Does echocardiography facilitate determination of hemodynamic significance attributable to the ductus arteriosus? Eur J Pediatr. 2009;168:907–914.
El-Khuffash AF, McNamara PJ. Neonatologist-performed functional echocardiography in the neonatal intensive care unit. Semin Fetal Neonatal Med. 2011:16;50–60.
Puddy VF, Amirmansour C, Williams AF, Singer DR. Plasma brain natriuretic peptide as a predictor of haemodynamically significant patent ductus arteriosus in preterm infants. Clin Sci (Lond). 2002;103:75–77.
Noori S, McCoy M, Friedlich P, Bright B, Gottipati V, Seri I, et al. Failure of ductus arteriosus closure is associated with increased mortality in preterm infants. Pediatrics. 2009;123:e138–144.
Laughon MM, Simmons MA, Bose CL. Patency of the ductus arteriosus in the premature infant: is it pathologic? Should it be treated? Curr Opin Pediatr. 2004;16:146–151.
Knight DB. Patent ductus arteriosus: how important to which babies? Early Hum Dev. 1992;29:287–292.
Dollberg S, Lusky A, Reichman B. Patent ductus arteriosus, indomethacin and necrotizing enterocolitis in very low birth weight infants; a population-based study. J Pediatr Gastroenterol Nutr. 2005;40:184–188.
Krauss AN, Fatica N, Lewis BS, Cooper R, Thaler HT, Cirrincione C, et al. Pulmonary function in preterm infants following treatment with intravenous indomethacin. Am J Dis Child. 1989;143:78–81.
Stefano JL, Abbasi S, Pearlman SA, Spear ML, Esterly KL, Bhutani VK. Closure of the ductus arteriosus with indomethacin in ventilated neonates with respiratory distress syndrome. Effects of pulmonary compliance and ventilation. Am Rev Respir Dis. 1991;143:236–239.
Gerhardt T, Bancalari E. Lung compliance in newborns with patent ductus arteriosus before and after surgical ligation. BioI Neonate. 1980;38:96–105.
Naulty CM, Horn S, Conry J, Avery GB. Improved lung compliance after ligation of patent ductus arteriosus in hyaline membrane disease. J Pediatr. 1978;93:682–684.
Fowlie PW, Davis PG, McGuire W. Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants. Cochrane Database Syst Rev. 2010;7:CD000I74.
Yeh TF, Luken JA, Thalji A, Raval D, Carr I, Pildes RS. Intravenous indomethacin therapy in premature infants with persistent ductus arteriosus — a double-blind controlled study. J Pediatr. 1981;98:137–145.
Edwards AD, Wyatt JS, Richardson C, Potter A, Cope M, Delpy DT, et al. Effects of indomethacin on cerebral haemodynamics in very preterm infants. Lancet. 1990;335:1491–1495.
Schmidt B, Davis P, Moddemann D, Ohlsson A, Roberts RS, Saigal S, et al. Long-term effects of Indomethacin prophylaxis in extremely low birth weight infants. N Engl J Med. 2001;344:1966–1972.
Moin F, Kennedy KA, Moya FR. Risk factors predicting vasopressor use after patent ductus arteriosus ligation. Am J Perinatol. 2003;20:313–320.
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.
Filan PM, Hunt RW, Anderson PJ, Doyle LW, Inder TE. Neurologic outcomes in very preterm infants undergoing surgery. J Pediatr. 2012;160:409–414.
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.
Teitel DF, Iwamoto HS, Rudolph AM. Effects of birthrelated events on central blood flow patterns. Pediatr Res. 1987;22:557–566.
Cooke L, Steer P, Woodgate P. Indomethacin for asymptomatic patent ductus arteriosus in preterm infants. Cochrane Database Syst Rev. 2003;CD003745.
Kluckow M. Abstracts of papers; Abstract 1675. Pediatric Academic Societies Annual Meeting; 2012 Apr 28–May 1. Boston, USA: Pediatric Academic Societies; 2012.
Tauzin L, Joubert C, Noel AC, Bouissou A, Moulies ME. Effect of persistent patent ductus arteriosus on mortality and morbidity in very low-birthweight infants. Acta Paediatr. 2012;101:419–423.
Ment LR, Oh W, Ehrenkranz RA, Philip AGS, Vohr B, Allan W, et al. Low dose indomethacin and prevention of intraventricular hemorrhage: A multicenter randomized trial. Pediatrics. 1994;93:543–550.
Fowlie PW, Davis PG. Prophylactic indomethacin for preterm infants: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2003;88:F464–466.
Ohlsson A, Shah SS. Ibuprofen for the prevention of patent ductus arteriosus in preterm and/or low birth weight infants. Cochrane Database Syst Rev. 2011;7:CD004213.
Wyllie J. Treatment of patent ductus arteriosus. Semin NeonatoI. 2003;8:425–432.
Knight DB. The treatment of patent ductus arteriosus in preterm infants. A review and overview of randomized trials. Semin NeonatoI. 2001;6:63–73.
Dani C, Bertini G, Corsini I, Elia S, Vangi V, Pratesi S, et al. 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.
Rajadurai VS, Yu VY. Intravenous indomethacin therapy in preterm neonates with patent ductus arteriosus. J Paediatr Child Health. 1991;27:370–375.
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;2:CD003480.
Gournay V, Roze JC, Kuster A, Daoud P, Cambonie G, Hascoet JM, et al. Prophylactic ibuprofen versus placebo in very premature infants: a randomised, double-blind, placebo-controlled trial. Lancet. 2004;364:1939–1944.
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. 2010;4:CD003481.
Cherif A, Khrouf N, Jabnoun S, Mokrani C, Amara MB, Guellouze N, et al. Randomized pilot study comparing oral ibuprofen with intravenous ibuprofen in very low birth weight infants with patent ductus arteriosus. Pediatrics. 2008;122:e1256–1261.
Allegaert K, Anderson B, Simons S, Overmeire BV. Paracetamol to induce ductus arteriosus closure: is it valid? Arch Dis Child. 2013;98:462–466.
Sangem M, Asthana S, Amin S. Multiple courses of indomethacin and neonatal outcomes in premature infants. Pediatr Cardiol. 2008;29:878–884.
Sperandio M, Beedgen B, Feneberg R, Huppertz C, Brussau J, Poschl J, et al. Effectiveness and side effects of an escalating, stepwise approach to indomethacin treatment for symptomatic patent ductus arteriosus in premature infants below 33 weeks of gestation. Pediatrics. 2005;116:1361–1366.
Hines MH, Raines KH, Payne RM, Covitz W, Cnota JF, Smith TE, et al. Video-assisted ductal ligation in premature infants. Ann Thorac Surg. 2003;76:1417–1420.
Alfaleh KM, Al Luwaimi E, Alkharfi TM, Al-Alaiyan SA. A decision aid for considering indomethacin prophylaxis vs. symptomatic treatment of PDA for extreme low birth weight infants. BMC Pediatr. 2011;11:78.
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Ibrahim, T.K., Abdul Haium, A.A., Chandran, S. et al. Current controversies in the management of patent ductus arteriosus in preterm infants. Indian Pediatr 51, 289–294 (2014). https://doi.org/10.1007/s13312-014-0403-2
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DOI: https://doi.org/10.1007/s13312-014-0403-2