Patent ductus arteriosus, its treatments, and the risks of pulmonary morbidity

Semin Perinatol. 2018 Jun;42(4):235-242. doi: 10.1053/j.semperi.2018.05.006. Epub 2018 May 10.

Abstract

A persistent left-to-right shunt through a patent ductus arteriosus (PDA) increases the rate of hydrostatic fluid filtration into the lung's interstitium, impairs pulmonary mechanics, and prolongs the need for mechanical ventilation. In preclinical trials, pharmacologic PDA closure leads to improved alveolarization and minimizes the impaired postnatal alveolar development that is the pathologic hallmark of bronchopulmonary dysplasia (BPD). Although routine prophylactic treatment of a PDA on the day of birth does not appear to offer any more protection against BPD than delaying treatment for 2-3 days, recent evidence from quality improvement trials suggests that early pharmacologic treatment decreases the incidence of BPD compared with a treatment approach that exposes infants to a moderate-to-large PDA shunt for the first 7-10 days after birth. After the first week, routine pharmacologic treatment (compared with continued PDA exposure) no longer appears to alter the course of BPD development. Evidence from epidemiologic, preclinical, and randomized controlled trials demonstrate that early ductus ligation is an independent risk factor for the development of BPD.

Keywords: Bronchopulmonary dysplasia; Chronic lung disease; Ibuprofen; Indomethacin; Patent ductus arteriosus; Pulmonary edema.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Age Factors
  • Bronchopulmonary Dysplasia / etiology*
  • Bronchopulmonary Dysplasia / physiopathology
  • Ductus Arteriosus, Patent / physiopathology
  • Ductus Arteriosus, Patent / surgery*
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Ligation / adverse effects*
  • Ligation / methods
  • Observational Studies as Topic
  • Randomized Controlled Trials as Topic
  • Respiration, Artificial / statistics & numerical data*
  • Retrospective Studies
  • Risk Factors