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Patent ductus arteriosus in preterm infants

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Abstract

Patent ductus arteriosus (PDA) is a major morbidity in preterm infants, especially in extremely premature infants less than 28 weeks. The clinical signs and symptoms of PDA in preterm infants are non specific and insensitive for making an early diagnosis of significant ductal shunting. Functional echocardiography is emerging as a new valuable bedside tool for early diagnosis of hemodynamically significant ductus, even though there are no universally accepted criteria for grading the hemodynamic significance. Echocardiography has also been used for early targeted treatment of ductus arteriosus, though the long term benefits of such strategy are debatable. The biomarkers like BNP and N-terminal pro-BNP are currently under research as diagnostic marker of PDA. The primary mode of treatment for PDA is pharmacological closure using cyclo-oxygenase inhibitors with closure rate of 70–80%. Oral ibuprofen is emerging as a better alternative especially in Indian scenario where parenteral preparations of indomethacin are unavailable and side effects are comparatively lesser. Though pharmacological closure of PDA is an established treatment modality, there is still lack of evidence for long term benefits of such therapy as well as there is some evidence for the possible adverse effects like increased ROP and BPD rates, especially if treated prophylactically. Hence, it is prudent to reserve treatment of PDA to infants with clinically significant ductus on the basis of gestation, birth weight, serial echocardiography and clinical status to individualize the decision to treat.

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References

  1. Shimada S, Kasai T, Konishi M, Fujiwara T. Effects of patent ductus arteriosus on left ventricular output and organ blood flows in preterm infants with respiratory distress syndrome treated with surfactant. J Pediatr. 1994;125:270–277.

    Article  PubMed  CAS  Google Scholar 

  2. Jegatheesan P, Lanus V, Buchh B, Yoon G BA, Chorne N, Ewig A, et al. Increased indomethacin dosing for persistent patent ductus arteriosus in preterm infants: a multicenter, randomized controlled trial. J Pediatr. 2008;153:183–189.

    Article  PubMed  CAS  Google Scholar 

  3. Gersony WM, Peckham GJ, Ellison RC, Miettinen OS, Nadas AS. Effect of indomethacin in premature infants with patent ductus arteriosus: result of national collaborative study. J Pediatr. 1983;102:895–905.

    Article  PubMed  CAS  Google Scholar 

  4. Nemerofsky SL, Parravicini E, Bateman D, Kleinman C, Polin RA, Lorenz JM. The ductus arteriosus rarely requires treatment in infants >1000 grams. Am J Perinatol. 2008;25:661–666.

    Article  PubMed  Google Scholar 

  5. Nemerofsky S, Parravicini E, Kleinman C,et al. The natural course of the ductus arteriosus in very low birthweight infants. E-PAS. 2006;59:542.

    Google Scholar 

  6. Rakza T, Magnenant E, Klosowski S, Tourneux P, Bachiri A, Storme L. Early hemodynamic consequences of patent ductus arteriosus in preterm infants with intrauterine growth restriction. J Pedatr. 2007;151:624–628.

    Article  CAS  Google Scholar 

  7. Dagle JM, Lepp NT, Cooper ME, Schaa KL, Kelsy KJ, Orr KL, et al. Determination of genetic predisposition to patent ductus arteriosus in preterm infants’” Pediatrics. 2009;123:1116–1123.

    Article  PubMed  Google Scholar 

  8. Shimada S, Kasai T, Konishi M, Fujiwara T. Effects of patent ductus arteriosus on left ventricular output and organ blood flows in preterm infants with respiratory distress syndrome treated with surfactant. J Pediatr. 1994;125:270–277.

    Article  PubMed  CAS  Google Scholar 

  9. Clyman R I. Mechanisms regulating the ductus arteriosus. Biol Neonate. 2006; 89:330–335.

    Article  PubMed  Google Scholar 

  10. Evans N, Moorcraft J. Effect of patency of the ductus arteriosus on blood pressure in very preterm infants. Arch Dis Child. 1992;67:1169–1173.

    Article  PubMed  CAS  Google Scholar 

  11. Lemmers PMA, Toet MC, van Bel F. Impact of patent ductus arteriosus and subsequent therapy with indomethacin on cerebral oxygenation in preterm infants’” Pediatrics. 2008;121:142–147.

    Article  PubMed  Google Scholar 

  12. Evans N, Malcolm G, Osborn D, Kluckow M. Diagnosis of patent ductus arteriosus in preterm infants. NeoReviews. 2004;5:86–97.

    Article  Google Scholar 

  13. Skinner J. Ductal shunting. In Skinner J, Hunter S, Alverson D eds. Echocardiography for the Neonatologist. London: Churchill Livingstone. 2000. p. 151–263.

    Google Scholar 

  14. Sehgal A, McNamara PJ. Does echocardiography facilitate determination of hemodynamic significance attributable to the ductus arteriosus. Eur J Pediatr. 2009;168:907–914.

    Article  PubMed  Google Scholar 

  15. Su BH, Peng CT, Tsai CH. Echocardiographic flow pattern of patent ductus arteriosus: a guide to indomethacin treatment in premature infants. Arch Dis Child Fetal Neonatal Ed. 1999;81:F197–F200.

    Article  PubMed  CAS  Google Scholar 

  16. Su BH, Lin HC, Chiu HY, Hsieh HY, Chen HH, Tsai YC. Comparison of ibuprofen and indomethacin for early targeted treatment of patent ductus arteriosus in extremely premature infants a randomized controlled trial. Arch Dis Child Fetal Neonatal. 2008;93:F94–F99.

    Article  Google Scholar 

  17. Braunwald E. Biomarkers of heart failure. N Engl J Med. 2008;358:2148–2159.

    Article  PubMed  CAS  Google Scholar 

  18. Koch A, Singer H. Normal values of B-type natriuretic peptide in infants, children and adolescents. Heart. 2003;89:875–878.

    Article  PubMed  CAS  Google Scholar 

  19. Choi BM, Lee KH, Eun BL. Utility of rapid B-type natriuretic peptide assay for diagnosis of symptomatic patent ductus arteriosus in preterm infants. Pediatrics. 2005;115:e255–261.

    Article  PubMed  Google Scholar 

  20. Narayanan-Sankar M, Clyman RI. Pharmacologic closure of patent ductus arteriosus in the neonate. NeoReviews. 2003;4:215–221.

    Article  Google Scholar 

  21. Fowlie PW, Davis PG. Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants. Cochrane Database Syst Rev. 2002;3:CD000174.

    PubMed  Google Scholar 

  22. Cooke L, Steer PA, Woodgate PG. Indomethacin for asymptomatic patent ductus arteriosus in preterm infants Cochrane Database Syst Rev. 2003;1:CD003745.

    Google Scholar 

  23. Herrera C, Holberton J, Davis PG. Prolonged versus short course of indomethacin for the treatment of patent ductus arteriosus in preterm infants. Cochrane Database Syst Rev. 2007;2:CD003480.

    PubMed  Google Scholar 

  24. Jegatheesan P, Lanus V, Buchh B, Yoon G BA, Chorne N, Ewig A, et al. Increased indomethacin dosing for persistent patent ductus arteriosus in preterm infants: a multicenter, randomized controlled trial. J Pediatr. 2008;153:183–189.

    Article  PubMed  CAS  Google Scholar 

  25. Gork AS, Ehrenkranz RA, Bracken MB. Continuous versus intermittent bolus doses of indomethacin for patent ductus arteriosus closure in symptomatic preterm infants. Cochrane Database Syst Rev. 2008;1:CD006071.

    PubMed  Google Scholar 

  26. Osborn DA, Evans N, Kluckow M. Effect of early targeted indomethacin on the ductus arteriosus and blood flow to the upper body and brain in the preterm infant. Arch Dis Child Fetal Neonatal Ed. 2003;88:F477–F482.

    Article  PubMed  CAS  Google Scholar 

  27. Ohlsson A, Walia R, Shah SS. Ibuprofen for the treatment of patent ductus arteriosus in preterm and/or low birth weight infants. Cochrane Database Syst Revs 2010;4:CD003481.

    Google Scholar 

  28. Van Overmeire B, Smets K, Lecoutere D, Van de Broek H, Weyler J, De Groote K, et al. A comparison of ibuprofen and indomethacin for closure of patent ductus arteriosus. N Engl J Med. 2000;343:674–681.

    Article  PubMed  Google Scholar 

  29. Gournay V, Roze MD, Kuster A, Daoud P, Cambonie G, Hascoet JM. Prophylactic ibuprofen versus placebo in very premature infants: a randomized, double-blind, placebo-controlled trial. Lancet. 2004;364:1939–1944.

    Article  PubMed  CAS  Google Scholar 

  30. 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–e1261.

    Article  PubMed  Google Scholar 

  31. O’Rourke DJ, El-Khuffash A, Moody C, Walsh K, Molloy EJ. Patent ductus arteriosus evaluation by serial echocardiography in preterm infants. Acta Paediatr. 2008;97:574–578.

    Article  PubMed  Google Scholar 

  32. Green TP, Thompson TR, Johnson De, Lock JE. Furosemide promotes patent ductus arteriosus in premature infants with respiratory distress syndrome. N Engl J Med. 1983;308:743–748.

    Article  PubMed  CAS  Google Scholar 

  33. Brion LP, Campbell DE. Furosemide for prevention of morbidity in indomethacin treated infants with patent ductus arteriosus. Cochrane Database Syst Rev. 2001;3:CD001148.

    PubMed  Google Scholar 

  34. Barrington KJ, Brion LP. Dopamine versus no treatment to prevent renal dysfunction in indomethacin treated preterm newborn infants. Cochrane Database Syst Rev. 2002;3:CD003213.

    PubMed  Google Scholar 

  35. Bose CL, Laughon MM. Patent ductus arteriosus: lack of evidence for common treatments. Arch Dis Child Fetal Neonatal Ed. 2007;92:F498–F502.

    Article  PubMed  Google Scholar 

  36. Benitz WE. Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis. J Perinatol. 2010;30:241–252.

    Article  PubMed  CAS  Google Scholar 

  37. Vanhaesebrouck S, Zonnenberg I, Vandervoort P, Bruneel E, Van Hoestenberghe M, Theyskens C. Conservative treatment for patent ductus arteriosus in the preterm Arch Dis Child Fetal Neonatal Ed. 2007;92:F244–F247.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India

    Arun Sasi & Ashok Deorari

  2. Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India

    Ashok Deorari

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  1. Arun Sasi
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  2. Ashok Deorari
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Correspondence to Ashok Deorari.

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Sasi, A., Deorari, A. Patent ductus arteriosus in preterm infants. Indian Pediatr 48, 301–308 (2011). https://doi.org/10.1007/s13312-011-0062-5

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