Ductus Arteriosus, Patent ; therapy ; Humans ; Infant, Newborn ; Infant, Premature

Disease Management ; Ductus Arteriosus, Patent ; therapy ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; therapy

Adult ; Device Removal ; methods ; Ductus Arteriosus, Patent ; Heart Septal Defects, Atrial ; therapy ; Humans ; Male

Patent ductus arteriosus (PDA) is a common problem encountered in the early neonatal period, particularly in preterm infants. Optimal management of PDA in preterm infants remains controversial. Despite considerable historical and physiological data indicating a persistent PDA may be harmful, robust evidence of long-term benefits or harms from treatment is lacking. This has been equated to a lack of benefit but is also a reflection of the fact that many clinical trials were designed to assess the effects of short-term (2-8 days) rather than prolonged exposure to a PDA. No clinical trials have been designed to assess the effects of prolonged exposure of persistent PDA on morbidity and mortality of very premature infants. Significant changes in management of PDA, i.e., less treatment for PDA, have evolved in recent years. This paper reviews the current literature and evidence for treatment options and research progress of PDA in infants with gestational age of <28 weeks.
Ductus Arteriosus, Patent ; therapy ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature

Adult ; Cardiac Catheterization ; instrumentation ; Ductus Arteriosus, Patent ; therapy ; Equipment Failure ; Female ; Humans ; Male ; Young Adult

Ductus Arteriosus, Patent ; drug therapy ; Humans ; Indomethacin ; therapeutic use ; Infant, Extremely Low Birth Weight ; Infant, Newborn

Acetaminophen ; therapeutic use ; Ductus Arteriosus, Patent ; drug therapy ; Humans ; Infant ; Infant, Newborn ; Infant, Premature

Adult ; Balloon Occlusion ; instrumentation ; Ductus Arteriosus, Patent ; complications ; therapy ; Equipment Design ; Female ; Humans ; Hypertension, Pulmonary ; complications

Cardiac Catheterization ; Ductus Arteriosus, Patent ; therapy ; Heart Septal Defects, Atrial ; therapy ; Humans ; Printing, Three-Dimensional ; Vena Cava, Inferior

OBJECTIVETo investigate the factors influencing the prognosis of patent ductus arteriosus (PDA) in very low birth weight (VLBW) infants.

METHODSA total of 194 VLBW infants who were admitted from January 2012 to December 2014 were enrolled as study subjects. According to cardiac ultrasound findings and treatment outcome, these infants were divided into non-PDA group, spontaneous closure group, pharmaceutical closure group, and surgical closure group. Their clinical and echocardiographic characteristics were analyzed.

RESULTSThe spontaneous closure rate of PDA was 58.7%. The spontaneous closure group showed significantly higher gestational age, birth weight, and proportion of small-for-gestational-age infants than the pharmaceutical and surgical closure groups (P<0.05). The pharmaceutical and surgical closure groups had a significantly higher incidence rate of neonatal respiratory distress syndrome and a significantly higher proportion of infants who were given pulmonary surfactant (PS) than the spontaneous closure group (P<0.05). During different periods of time, the spontaneous closure group had a significantly smaller ductus arteriosus diameter than the pharmaceutical and surgical closure groups (P<0.05). The multivariate logistic regression analysis showed that gestational age, application of PS, and ductus arteriosus diameter at 48 hours were significantly associated with the prognosis of PDA. The major transductal flow pattern in the spontaneous closure group was closing pattern, while in the pharmaceutical and surgical closure groups, the main flow patterns were pulmonary hypertension and growing patterns within 48 hours and growing pattern on days 4 and 7.

CONCLUSIONSThe VLBW infants have a high spontaneous closure rate of PDA. A decreased closure rate of PDA is associated with the lower gestational age and the application of PS. PDA with a large ductus arteriosus diameter and a growing or pulsatile flow pattern cannot easily achieve spontaneous closure.

Ductus Arteriosus, Patent ; physiopathology ; therapy ; Echocardiography ; Female ; Humans ; Infant, Newborn ; Infant, Very Low Birth Weight ; Male ; Prognosis