-
Pediatrics in Review Nov 2021
Topics: Ductus Arteriosus, Patent; Humans; Infant, Newborn; Persistent Fetal Circulation Syndrome
PubMed: 34725225
DOI: 10.1542/pir.2020-004564 -
Pediatrics and Neonatology Apr 2020The ductus arteriosus is likely to close without treatment in most infants born at gestational age (GA) > 28 weeks (73%), and those with birth weight > 1000 g... (Review)
Review
The ductus arteriosus is likely to close without treatment in most infants born at gestational age (GA) > 28 weeks (73%), and those with birth weight > 1000 g (94%). However, the rates of spontaneous ductal closure among less mature or smaller infants with respiratory distress syndrome are not known. Extremely preterm infants born at GA < 28 weeks are associated with a high risk of severe intraventricular hemorrhage (IVH) or pulmonary hemorrhage, which usually occur within 72 h after birth and affect mortality and long-term neurological development. These serious hemorrhagic complications may be closely related to hemodynamic changes caused by a hemodynamically significant patent ductus arteriosus (hs-PDA). While prophylactic indomethacin has been shown to reduce the rates of PDA, PDA ligation, severe IVH and early pulmonary hemorrhage, the available evidence does not support its prophylactic use in preterm infants. Symptomatic or late treatment is associated with lower success rate, and increased complications of a hs-PDA. The issue of "to treat or not to treat a PDA" is controversial. Considering the relationship between the effectiveness and timing of pharmacological treatment, early targeted treatment may be an alternative approach for the early identification of a hs-PDA in specific high-risk patient population, especially infants <26 weeks GA who are at the highest risk of severe IVH or pulmonary hemorrhage. Serial echocardiographic studies can be used to select patients who are candidates for early targeted medical treatment of hs-PDA. Surgical ligation of PDA, and transcatheter closure if proven to be safe, can be used as back-up therapy for patients who fail medical treatment and continue to have cardiopulmonary compromise.
Topics: Acetaminophen; Ductus Arteriosus, Patent; Echocardiography; Humans; Indomethacin; Infant, Extremely Premature; Infant, Newborn; Ligation
PubMed: 31740267
DOI: 10.1016/j.pedneo.2019.10.002 -
Scientific Reports May 2021To evaluate national epidemiologic data on infants treated for patent ductus arteriosus (PDA) in Korea and analyze outcomes associated with different PDA treatments. We...
To evaluate national epidemiologic data on infants treated for patent ductus arteriosus (PDA) in Korea and analyze outcomes associated with different PDA treatments. We retrospectively evaluated data on 12,336 patients diagnosed with PDA (International Classification of Diseases-10 code: Q250) between 2015 and 2018 from the Health Insurance Review and Assessment database. Among them, 1623 patients underwent surgical ligation (code: O1671). We used birth certificate data from Statistics Korea to estimate the prevalence, diagnosis, and treatment of PDA. The prevalence of infants with PDA was 81 infants per 10,000 live births and 45.2% in very low birth weight (VLBW) infants, which increased from 2015 to 2018. PDA ligation was performed in 2571 infants and 22% VLBW infants. Medical treatment was administered to 4202 infants, which decreased significantly, especially in VLBW infants (62% to 53%). The proportion of treatment was as follows: conservative treatment (53.1%), intravenous ibuprofen (24.4%), surgery (20.4%), and oral ibuprofen (10.7%); that among 4854 VLBW infants was as follows: intravenous ibuprofen (46.3%), conservative treatment (33.2%), surgery (22.2%), and oral ibuprofen (14.2%). Surgical treatment had a significantly higher risk (odds ratio 1.36) of mortality than conservative treatment. Surgical and/or medical treatments were associated with a higher risk of morbidity. Recently, increased use of conservative management of PDA has contributed to improved neonatal outcomes in VLBW infants. Select patients may still benefit from surgical ligation following careful consideration.
Topics: Clinical Decision-Making; Combined Modality Therapy; Disease Management; Ductus Arteriosus, Patent; Humans; Infant, Newborn; Odds Ratio; Outcome Assessment, Health Care; Prevalence
PubMed: 34021202
DOI: 10.1038/s41598-021-89868-z -
Advances in Neonatal Care : Official... Jun 2019Patent ductus arteriosus (PDA) is the persistence of a fetal shunt between the pulmonary artery and the aorta. This structure normally closes in the first 3 days after... (Review)
Review
BACKGROUND
Patent ductus arteriosus (PDA) is the persistence of a fetal shunt between the pulmonary artery and the aorta. This structure normally closes in the first 3 days after birth; however, closure is delayed in up to 80% of infants born at 25 to 28 weeks of gestation. Persistent PDA results in pulmonary overcirculation and systemic hypoperfusion.
PURPOSE
The purpose of this article is to review pathophysiology and treatment options for PDA.
METHODS
A literature review was conducted using PubMed, CINAHL, and Google Scholar (2013-2018). Search terms included neonate, PDA, pathophysiology, pharmacotherapy, nursing, ligation, indomethacin, ibuprofen, and acetaminophen (paracetamol).
RESULTS
Optimal treatment remains contentious. Options include conservative/medical, pharmacologic, and surgical management. Conservative/medical management includes mild fluid restriction, increased airway pressures, and supportive care. Pharmacologic treatment is accomplished using indomethacin, ibuprofen, or acetaminophen. Surgical intervention is by direct closure or by percutaneous ligation. Treatment may be prophylactic, presymptomatic, or symptomatic. Long-term morbidities associated with PDA include chronic lung disease, retinopathy of prematurity, and neurodevelopmental delay.
IMPLICATIONS FOR RESEARCH
Absence of a universal scoring system for severity of PDA limits accuracy of comparisons among research studies. Lack of a consistent definition also makes it difficult to aggregate data for meta-analyses. Adoption of a consistent scoring system for hemodynamic significance would facilitate comparisons of outcomes among research studies.
IMPLICATIONS FOR PRACTICE
Clinicians should be aware of treatment options for PDA and their implications on neonatal outcomes. For nurses, anticipation of possible side effects is important for performance of focused assessments.
Topics: Cardiovascular Physiological Phenomena; Continuous Positive Airway Pressure; Cyclooxygenase Inhibitors; Diuretics; Ductus Arteriosus; Ductus Arteriosus, Patent; Echocardiography, Doppler; Endovascular Procedures; Fetus; Humans; Infant, Extremely Premature; Infant, Newborn; Ligation; Persistent Fetal Circulation Syndrome; Positive-Pressure Respiration; Respiration, Artificial; Time Factors
PubMed: 30720481
DOI: 10.1097/ANC.0000000000000590 -
Seminars in Perinatology Mar 2023The hemodynamically significant patent ductus arteriosus (hsPDA) is a controversial topic in neonatology, particularly among neonates at the earliest gestational...
The hemodynamically significant patent ductus arteriosus (hsPDA) is a controversial topic in neonatology, particularly among neonates at the earliest gestational ages of 22-23 weeks. There is little, to no data on the natural history or impact of the PDA in extremely preterm babies. In addition, these high-risk patients have typically been excluded from randomized clinical trials of PDA treatment. In this work, we present the impact of early hemodynamic screening (HS) of a cohort of patients born 22-23 weeks gestation who either were diagnosed with hsPDA or died in the first postnatal week as compared to a historical control (HC) cohort. We also report a comparator population of 24-26 weeks gestation. All patients in the HS epoch were evaluated between 12-18h postnatal age and treated based on disease physiology whereas the HC patients underwent echocardiography at the discretion of the clinical team. We demonstrate a two-fold reduction in the composite primary outcome of death prior to 36 weeks or severe BPD and report a lower incidence of severe intraventricular hemorrhage (n=5, 7% vs n=27, 27%), necrotizing enterocolitis (n=1, 1% vs n=11, 11%) and first-week vasopressor use (n=7, 11% vs n=40, 39%) in the HS cohort. HS was also associated with an increase in survival free of severe morbidity from the already high rate of 50% to 73% among neonates <24 weeks gestation. We present a biophysiological rationale behind the potential modulator role of hsPDA on these outcomes and review the physiology relevant to neonates born at these extremely preterm gestations. These data highlight the need for further interrogation of the biological impact of hsPDA and impact of early echocardiography directed therapy in infants born less than 24 weeks gestation.
Topics: Infant, Newborn; Humans; Infant; Ductus Arteriosus, Patent; Infant, Extremely Premature; Gestational Age; Enterocolitis, Necrotizing; Echocardiography
PubMed: 36882362
DOI: 10.1016/j.semperi.2023.151721 -
Cardiology Clinics Nov 2015Intracardiac shunts are among the most common cardiac lesions seen in adult patients with congenital heart disease. Shunt lesions comprise much of the de novo congenital... (Review)
Review
Intracardiac shunts are among the most common cardiac lesions seen in adult patients with congenital heart disease. Shunt lesions comprise much of the de novo congenital heart disease diagnosed in adults and engender a wide range of pathophysiologic consequences with a variety of treatment options. This article discusses the pathophysiology, clinical presentation, indications for intervention, late management issues, and pregnancy in adults with atrial septal defects, ventricular septal defects, and patent ductus arteriosus.
Topics: Adult; Ductus Arteriosus, Patent; Female; Heart Septal Defects, Atrial; Heart Septal Defects, Ventricular; Humans; Male; Pregnancy
PubMed: 26471816
DOI: 10.1016/j.ccl.2015.07.009 -
Archives of Disease in Childhood. Fetal... Mar 2023As the approach to the patent ductus arteriosus (PDA) in the preterm infant remains controversial, the potential consequences of a significant ductal shunt on the brain... (Review)
Review
As the approach to the patent ductus arteriosus (PDA) in the preterm infant remains controversial, the potential consequences of a significant ductal shunt on the brain should be evaluated. In this population at high risk of adverse outcomes, including intraventricular haemorrhage and white matter injury, as well as longer-term neurodevelopmental impairment, it is challenging to attribute sequelae to the PDA. Moreover, individual patient characteristics including gestational age and timing of PDA intervention factor into risks of brain injury. Haemodynamic assessment of the ductus combined with bedside neuromonitoring techniques improve our understanding of the role of the PDA in neurological injury. Effects of various PDA management strategies on the brain can similarly be investigated. This review incorporates current understanding of how the PDA impacts the developing brain of preterm infants and examines modalities to measure these effects.
Topics: Infant; Infant, Newborn; Humans; Infant, Premature; Ductus Arteriosus, Patent; Ductus Arteriosus; Gestational Age; Brain Injuries; Brain
PubMed: 35732482
DOI: 10.1136/archdischild-2022-324111 -
Giornale Italiano Di Cardiologia (2006) Apr 2015The ductus arteriosus is a physiological structure allowing shunt of blood from the pulmonary artery to the descending aorta during fetal life (unventilated lung). The... (Review)
Review
The ductus arteriosus is a physiological structure allowing shunt of blood from the pulmonary artery to the descending aorta during fetal life (unventilated lung). The incidence of isolated patent ductus arteriosus (PDA) in children born at term is about 1 per 2000 live births, accounting for 5-10% of all congenital heart defects. The pathophysiological significance and management of PDA vary according to the clinical context (isolated anomaly or as part of complex congenital heart disease), magnitude of the shunt, and stadium within the natural history. This review summarizes the embryogenetic, pathophysiological, clinical and therapeutic basic concepts for an updated approach to this particular heart disease commonly seen even by the cardiologist of the adult.
Topics: Adult; Aorta, Thoracic; Ductus Arteriosus, Patent; Heart Defects, Congenital; Humans; Incidence; Infant, Newborn; Pulmonary Artery
PubMed: 25959759
DOI: 10.1714/1848.20188 -
The Veterinary Record Jul 2016
Topics: Animals; Cat Diseases; Cats; Ductus Arteriosus, Patent; United Kingdom
PubMed: 27365241
DOI: 10.1136/vr.i3532 -
Congenital Heart Disease Sep 2018
Review
Topics: Cardiac Surgical Procedures; Conservative Treatment; Ductus Arteriosus, Patent; Hemodynamics; Humans; Infant, Newborn
PubMed: 30536607
DOI: 10.1111/chd.12689