Hanyang Med Rev.  2009 Nov;29(4):315-326. 10.7599/hmr.2009.29.4.315.

Recent Advance in Management of Patent Ductus Arteriosus in Extremely Low Birth Weight Infants

• Choi BM

• KMID: 2053718
• DOI: http://doi.org/10.7599/hmr.2009.29.4.315

Abstract

Management of patent ductus arteriosus (PDA) in preterm infants has always been a challenge to the neonatologist and continues to be a controversial topic. There is no evidence that medical treatment with cyclooxygenase inhibitors for the prevention and treatment of PDA decreases mortality or serious morbidity, despite success in closure of the PDA. In practice, however, treatment decisions should be made for individual preterm infants in the absence of knowledge about benefits and risks of medical treatment should be made on the individual basis. This article attempts to review the current available, often conflicting data and to present the clinical guidelines for management of PDA in preterm infants, especially for extremely low birth weight (ELBW) infants. Prophylactic or early pre-symptomatic treatment may unnecessarily expose these infants, in whom the ductus might close spontaneously, to pharmacologic agents and their adverse effects. On the other hand, with advancing postnatal age, delayed treatment could potentially decrease successful medical closure thereby increasing the rate of surgical ligation and the complications associated with surgery. Therefore early symptomatic treatment in ELBW infants is preferred as the primary pharmacologic treatment for PDA. Conservative treatment with adjustment of ventilation and fluid restriction is beneficial as an alternative management to prophylactic pharmacologic treatment.

Keyword

Patent ductus arteriosus; Indomethacin; Ibuprofen; Extremely low birth weight infant

MeSH Terms

Cyclooxygenase Inhibitors
Ductus Arteriosus, Patent
Hand
Humans
Ibuprofen
Indomethacin
Infant
Infant, Extremely Low Birth Weight
Infant, Low Birth Weight
Infant, Newborn
Infant, Premature
Ligation
Risk Assessment
Ventilation
Cyclooxygenase Inhibitors
Ibuprofen
Indomethacin

Figure

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  Fig. 1 Comparison of ventilator wave for. Volume-targeted ventilation (A), and pressure-targeted ventilation.

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  Fig. 2 A potential for overdistension of the lungs in the face of improving compliance with pressure-targeted ventilation. In pretrm infants with RDS, at a given pressure, tidal volume delivery will be lower when the lungs are stiff, and when compliance improves after surfactant relacement therapy, the same amount of pressure will deliver a larger tidal volume.

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  Fig. 3 Hyblid modalities are primarily pressure-targeted modes of ventilation but involve computerized servo-controlled ventilation, in which the ventilator has an algorithm that adjusts the rise and fall of pressure to produce tidal volume delivery based on the previous breaths.

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  Fig. 4 Waveforms of patient-triggered ventilation. (A) Synchronized Intermittent mandatory ventilation (SIMV). (B) Flow-cycled Presssure Support Ventilation.

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  Fig. 5 Concept of Neurally Adjusted Ventilatory Assist (NAVA).

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  Fig. 6 Measuring of electric diaphragm activity (A) and NAVA gain (B).

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