Understanding the Pathophysiology, Implications, and Treatment Options of Patent Ductus Arteriosus in the Neonatal Population

Adv Neonatal Care. 2019 Jun;19(3):179-187. doi: 10.1097/ANC.0000000000000590.


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.

Publication types

  • Review

MeSH terms

  • Cardiovascular Physiological Phenomena
  • Continuous Positive Airway Pressure / methods
  • Cyclooxygenase Inhibitors / therapeutic use
  • Diuretics / therapeutic use
  • Ductus Arteriosus / physiology*
  • Ductus Arteriosus, Patent / diagnostic imaging
  • Ductus Arteriosus, Patent / physiopathology*
  • Ductus Arteriosus, Patent / therapy
  • Echocardiography, Doppler
  • Endovascular Procedures / methods
  • Fetus / physiology
  • Humans
  • Infant, Extremely Premature
  • Infant, Newborn
  • Ligation / methods
  • Persistent Fetal Circulation Syndrome / physiopathology*
  • Positive-Pressure Respiration / methods
  • Respiration, Artificial / methods
  • Time Factors


  • Cyclooxygenase Inhibitors
  • Diuretics