[Patent ductus arteriosus in premature infants].
BACKGROUND
Patent ductus arteriosus in premature infants has often been treated because of its association with worsening of pulmonary disease and complications such as bronchopulmonary dysplasia. This view has now been challenged.


METHODS
Relevant publications have been identified from review articles in international peer-reviewed journals. The articles have been retrieved through searches in the PubMed and Cochrane-databases.


RESULTS
Recent research has led to a new understanding of patent ductus arteriosus - a shift of paradigm has occurred. The condition implies that a shunt enables blood to flow from right to left in the first postnatal days (when pulmonary arterial pressure is high), and left to right in cases where significant pulmonary disease is present. The increased pulmonary blood flow improves oxygenation, and the condition should be considered as physiological in small premature infants. A patent ductus arteriosus does not worsen concomitant pulmonary disease or increase the risk of bronchopulmonary dysplasia, intraventricular hemorrhage, necrotising enterocolitis or other complications.


CONCLUSIONS
Treatment of a patent ductus arteriosus with COX-inhibitors such as indomethacin and ibuprofen, increases the risk for bronchopulmonary dysplasia without reducing other complications or death. A large patent ductus arteriosus has significant hemodynamic effects and should be treated with fluid restriction, diuretics and inotropic drugs before closure is considered. Surgical closure of a patent ductus arteriosus is linked to neurosensory impairment in survivors.
Bratlid
Dag
D
Barne- og ungdomsklinikken, St. Olavs hospital og Institutt for laboratoriemedisin, Det medisinske fakultet, Norges teknisk-naturvitenskapelige universitet, 7006 Trondheim, Norway. dag.bratlid@ntnu.no
Farstad
Teresa
T
D001997:Bronchopulmonary Dysplasia / Q000209:etiology; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use; D007213:Indomethacin / Q000627:therapeutic use; D007231:Infant, Newborn; D007234:Infant, Premature; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors
D016861:Cyclooxygenase Inhibitors; D007052:Ibuprofen; D007213:Indomethacin