Patent ductus arteriosus in premature infants. Literature review

The diagnosis of patent ductus arteriosus (PDA) is crucial in the neonatal period since this defect is present in 40% of preterm infants with respiratory distress. In patients with a clinical suspicion of PDA, Doppler studies should be done to evaluate the hemodynamic impact of the shunt on the lungs, brain, kidneys, intestines, and heart. Rapid closure of the PDA should be obtained since the beneficial effects of the shunt are rapidly cancelled out by negative effects associated with increased morbidity and mortality, including cardiocirculatory failure, hemorrhagic pulmonary edema, pulmonary hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, poor gastrointestinal tolerance to feeding, cerebral hemorrhage, and an increased length of the hospital stay. Closure can be achieved by indomethacin therapy or surgery. Indomethacin can be given either routinely as low-dose prophylactic therapy started at birth or only to those infants with symptomatic PDA (40% of cases). The latter option may be preferable since indomethacin has a number of adverse effects. Recent improvements and simplifications in surgical techniques have made surgery an excellent therapeutic alternative.