There have been many studies in our journal and others over the years regarding best ways to close a patent ductus arteriosus (PDA). But what if we just left the PDA alone to close by itself spontaneously? Would this be of benefit or harm to a very low birth weight (VLBW) infant? Semberova et al. (10.1542/peds.2016-4258) got to the heart of this matter by performing a retrospective cohort study in two neonatal intensive care units in Europe. The authors studied 368 VLBW infants of which 297 were free of congenital heart malformations and were discharged home. 280 were simply followed for their PDAs with serial echocardiography and of note, 85% of them had closed spontaneously prior to hospital discharge. What was associated with closure sooner than later? Were there any associated morbidities with not aggressively closing the PDA surgically prior to discharge?
You will be happy to learn in this study that the answer to this last question is “no,” and as to associations with earlier spontaneous closure, the study outlines possible predictors of ductus closure as well. So does this mean leaving the PDA to close on its own should be done for all babies? Not at all. In fact, there were a small percentage of infants in this study that did need their PDAs closed surgically, medically, or through interventional catheterization. More work is needed to better understand when is a PDA’s lack of closure a concern for pulmonary hypertension and other complications. Neonatologist Dr. William Benitz from Stanford shares his perspective (10.1542/peds.2017-0566) on this study and its implications in an accompanying commentary. We hope you open up this study and commentary rather than spontaneously close your mind to what it offers in terms of new thinking as to how we should handle PDAs in VLBW infants.
