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What is new for patent ductus arteriosus management in premature infants in 2015?

Perez, Krystle M.; Laughon, Matthew M.

Current Opinion in Pediatrics: April 2015 - Volume 27 - Issue 2 - p 158–164
doi: 10.1097/MOP.0000000000000200
NEONATOLOGY AND PERINATOLOGY: Edited by Richard A. Polin and Tara M. Randis
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Purpose of review A patent ductus arteriosus (PDA) in premature infants is common and is associated with a number of adverse outcomes. The purpose of this review is to discuss recent literature in PDA diagnosis and management.

Recent findings The diagnosis of a ‘hemodynamically significant’ PDA is challenging and a robust definition is lacking. The risks and benefits of therapies, either medical or surgical, designed to close the PDA, are controversial. Oral acetaminophen has gained increasing attention as an alternative pharmaceutical agent for PDA closure in premature infants, although safety concerns remain. Compared to surgical ligation, transcatheter PDA closure may be associated with less risk and fewer adverse events. Both aggressive and conservative management of PDA has similar clinically important outcomes, although the strength of evidence is derived mostly from cohort studies.

Summary Clinicians should weigh the potential adverse effects of pharmaceutical or surgical PDA closure against the likelihood of spontaneous closure. The infant population most likely to benefit from PDA closure remains ill-defined and clinical context is recommended.

Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

Correspondence to Matthew M. Laughon, MD, MPH, Division of Neonatal-Perinatal Medicine, UNC Hospital, CB#7596, Chapel Hill, NC 27599-7596, USA. E-mail: matt_laughon@med.unc.edu

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.