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NeoReviews Vol.9 No.10 2008 e477
© 2008 American Academy of Pediatrics

Controversies in the Management of Patent Ductus Arteriosus

Jason Gien, MD*

* Department of Pediatrics, Section of Neonatology, University of Colorado Health Sciences Center, Boulder, Colo

Exposure to a chronic persistent patent ductus arteriosus (PDA) is associated with several neonatal morbidities, but whether such outcomes are as a result of a persistent left-to-right shunt across the PDA or as a consequence of prematurity remains in question. Animal studies have shown significant benefit to early PDA closure, but such findings have not been replicated in any human trial. Both pharmacologic and surgical treatment options exist for closing a PDA, both of which have their own morbidities. Although the incidence of PDA is high in preterm infants, there also is a high rate of spontaneous PDA closure. Treatment of a PDA is not benign and has not been shown to prevent any morbidities associated with prematurity. For this reason, there has been much debate in recent years as to when a PDA is pathologic and when closure is indicated. This discussion focuses on the debate, treatment options for PDA, and outcomes associated with PDA and its treatment.

Abbreviations: BPD: bronchopulmonary dysplasia • CLD: chronic lung disease • NEC: necrotizing enterocolitis • PDA: patent ductus arteriosus • RDS: respiratory distress syndrome


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