Patent Ductus Arteriosus in Preterm Infants.
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Date
2011-04
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Abstract
Patent ductus arteriosus (PDA) is a major morbidity in preterm infants, especially in extremely premature infants less than
28 weeks. The clinical signs and symptoms of PDA in preterm infants are non specific and insensitive for making an early
diagnosis of significant ductal shunting. Functional echocardiography is emerging as a new valuable bedside tool for early
diagnosis of hemodynamically significant ductus, even though there are no universally accepted criteria for grading the
hemodynamic significance. Echocardiography has also been used for early targeted treatment of ductus arteriosus,
though the long term benefits of such strategy are debatable. The biomarkers like BNP and N- terminal pro–BNP are
currently under research as diagnostic marker of PDA. The primary mode of treatment for PDA is pharmacological closure
using cyclo-oxygenase inhibitors with closure rate of 70-80%. Oral ibuprofen is emerging as a better alternative especially
in Indian scenario where parenteral preparations of indomethacin are unavailable and side effects are comparatively
lesser. Though pharmacological closure of PDA is an established treatment modality, there is still lack of evidence for long
term benefits of such therapy as well as there is some evidence for the possible adverse effects like increased ROP and
BPD rates, especially if treated prophylactically. Hence, it is prudent to reserve treatment of PDA to infants with clinically
significant ductus on the basis of gestation, birth weight, serial echocardiography and clinical status to individualize the
decision to treat.
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Keywords
Functional echocardiography, Ibuprofen, Indomethacin, Preterm infant, Patent ductus arteriosus
Citation
Sasi Arun, Deorari Ashok. Patent Ductus Arteriosus in Preterm Infants. Indian Pediatrics. 2011 Apr; 48(4): 301-308.