Open Access, Peer-reviewed
pISSN 2508-4887
eISSN 2508-4895
    Korean J Perinatol. 2013 Jun;24(2):72-81. Korean.
    Published online Jun 30, 2013.
    https://doi.org/10.14734/kjp.2013.24.2.72
    Copyright © 2013 The Korean Society of Perinatology
    Review

    Strategy of Dagnosis and Treatment for Hemodynamically Significant Patent Ductus Arteriosus in Preterm Infants

    Jung Ha Lee, M.D., Ph.D.
      • Department of Pediatrics, Ilsan Hospital, Dongguk University, Goyang, Korea.
    • Corresponding author (Email: michel@dumc.or.kr )
    Received June 07, 2013; Revised June 23, 2013; Accepted June 24, 2013.

    Abstract

    Patent ductus arteriosus (PDA) is a major morbidity in preterm infants, especially in extremely premature infants less than 28 weeks. Early diagnosis of hemodynamically significant PDA (hs-PDA) is not easy because the symptoms of PDA in preterm infants are non-specific. Echocardiography is a good diagnostic tool for early detection of PDA. Clinical investigation has been continued to establish a criteria for selecting an infant who needs early targeted treatment of PDA by echocardiography. The biomarkers such as brain natriuretic peptide (BNP) and N-terminal pro-BNP (NTpBNP) are currently under research as a diagnostic and prognostic marker of PDA. Cyclooxygenase (COX) inhibitor is the treatment of choice and highly effective for PDA closure in preterm infants. Oral ibuprofen is emerging as a better alternative because it is as effective as indomethacin with fewer side effects. PDA ligation is a treatment option for hs-PDA when medical treatment is failed. There is lack of long term benefits of such treatments to induce ductal closure. Thus, it is prudent to treat an infant with clinically significant PDA on the basis of gestational age, birth weight, clinical status, and echocardiographic findings. Better diagnostic tools to identify infants who might benefit from ductal closure are needed.

    Keywords
    Patent ductus arteriosus; Preterm; Management; Ibuprofen

    Tables

    Table 1
    Rates of Spontaneous Ductus Arteriosus Closure (%)17-20

    Table 2
    Proposed Staging System (Adapted from McNamara and Hellman, Unpublished Clinical Triaging System for Ligation of a Patent Ductus Arteriosus (PDA)) for Determining the Magnitude of the Haemodynamically Significant Ductus Arteriosus (HSDA), Which Is Based on Clinical and Echocardiographic Criteria

    Table 3
    Comparison of Echocardiographic Markers of Hemodynamically Significant Patent Ductus Arteriosus

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    MeSH Terms
    Biomarkers
    Birth Weight
    Ductus Arteriosus, Patent
    Early Diagnosis
    Echocardiography
    Gestational Age
    Humans
    Ibuprofen
    Indomethacin
    Infant
    Infant, Extremely Premature
    Infant, Newborn
    Infant, Premature
    Ligation
    Natriuretic Peptide, Brain
    Peptide Fragments
    Prostaglandin-Endoperoxide Synthases
    Metrics
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