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7688297 
Journal Article 
Management of patent ductus arteriosus in premature infants 
Bhat, R; Das, UG; , 
2015 
Yes 
Indian Journal of Pediatrics
ISSN: 0019-5456
EISSN: 0973-7693 
SPRINGER INDIA 
NEW DELHI 
82 
1 
53-60 
English 
25532746 
WOS:000351564100012 
Patency of the ductus arteriosus is required for fetal survival in utero. In infants born prematurely, ductus fails to close and shunt reverses from left to right. Incidence of patent ductus arteriosus (PDA) is inversely proportional to the gestational age. A large PDA (>1.5 mm diameter) with left to right shunt in very low birth weight infants can cause pulmonary edema, congestive heart failure, pulmonary hemorrhage and increase the risk for bronchopulmonary dysplasia. Attempts to prevent or close the duct by pharmacological or surgical methods have not changed the morbidity or the long term outcome. Pharmacological treatment with indomethacin or ibuprofen is successful in 75 to 80 % of infants but its use also exposes these infants to undesirable side effects like gastrointestinal bleeding, perforation and necrotizing enterocolitis. Prophylactic therapy with indomethacin or ibuprofen to prevent PDA has not altered the morbidity or long term outcome. Currently, there is a dilemma as to how to treat, when to treat and whom to treat. Recent literature suggests a trial of conservative management during the first week followed by selective use of anti-inflammatory drugs. Surgical ligation is reserved for infants who fail medical therapy and still remain symptomatic. Spontaneous closure of the PDA has been reported in up to 40-67 % of very low birth weight (VLBW) infants by 7 d. In this review authors discuss these controversies and propose a more rational approach. 
BNP: Brain natriuretic peptide; hsPDA: Hemodynamically significant PDA; NSAID: Non-steroidal anti inflammatory drugs; NT pro BNP: N-terminal-pro-B natriuretic peptide; TnT: Troponin T; VEGF: Vascular endothelial growth factor; VLBW: Very low birth weight