PERSPECTIVES
Staging of PDAs
Towards rational management of the patent ductus arteriosus: the need for disease staging
The Hospital for Sick Children Research Institute, Division of Neonatology, University of Toronto, Toronto, Canada
Correspondence to:
Patrick J McNamara, The Hospital for Sick Children, 555 University Avenue, Toronto M5G 1X8, Canada; patrick.mcnamara@sickkids.ca
Perspective on the review by Bose and Laughon (see page 498)
Abbreviations: CLD, chronic lung disease; ELBW, extremely low birthweight; HSDA, haemodynamically significant ductus arteriosus; PDA, patent ductus arteriosus
Keywords: ductal ligation; indometacin; patent ductus arteriosus; staging
| The first 150 words of the full text of this article appear below. |
Patent ductus arteriosus (PDA) is common problem, with rates of 40–55% in babies born less than 29 weeks’ gestation,1 2 yet decisions related to management remain highly controversial. Despite numerous studies on the topic there remains uncertainty with respect to diagnosis, assignment of clinical importance, whether treatment is indicated and if so the preferred treatment modality. The most fundamental question remains unanswered: does a PDA cause acute physiological or clinical change that either acutely or chronically leads to organ damage, which further leads to important neonatal morbidities? Put simply is the PDA an "innocent bystander" or is it pathological to the extent that early detection and intervention is warranted to prevent neonatal morbidity?
It is physiologically plausible that a major systemic to pulmonary (left-to-right) shunt can lead to considerable postnatal morbidities in extremely low birthweight (ELBW) infants, either from pulmonary overcirculation (eg, chronic lung disease (CLD)) and/or systemic
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