The evidence available to guide evaluation and treatment of preterm infants with patent ductus arteriosus (PDA) in the first few weeks after birth is summarized in a new AAP clinical report.
Patent Ductus Arteriosus in Preterm Infants, from the AAP Committee on Fetus and Newborn, is available at http://pediatrics.aappublications.org/cgi/doi/10.1542/peds.2015-3730 and is published in the January issue of Pediatrics.
Prolonged ductal patency is associated with numerous adverse outcomes, including prolongation of assisted ventilation and higher rates of death, bronchopulmonary dysplasia, intraventricular hemorrhage (IVH), periventricular leukomalacia and cerebral palsy.
The hypothesis that pharmacological or surgical intervention to close the ductus might reduce the severity of these common complications of prematurity has resulted in widespread adoption of interventions to achieve early closure of the ductus in preterm infants.
Since early reports of the feasibility of surgical closure and efficacy of nonsteroidal anti-inflammatory drugs for treatment of PDA, a large body of evidence has demonstrated that early, routine treatment to induce closure of the ductus in the first two weeks after birth does not improve long-term outcomes.
Prophylactic use of indomethacin may be appropriate in settings where rates of IVH are high or if early, severe pulmonary hemorrhage is common, but may not be justified by expected effects on PDA or by an expectation of better long-term outcomes, according to the report.
The lack of evidence to guide management of PDA necessitates enrollment of infants in clinical trials to study treatment options.
Research must address the relationship between measures of hemodynamic significance and increased risks for prolonged patency and adverse clinical outcomes, according to the report. In addition, well-designed and meticulously executed intervention trials are needed for which the end points are clinically important long-term outcomes and not just rates of ductal closure or measures of short-term physiologic changes, the report concludes.
