title: Managing the patent ductus arteriosus in the premature neonate: a new look at what we thought we knew.
abstract: Over recent years, the clinical approach to patency of the ductus arteriosus in the premature neonate has been the subject of intensive reevaluation. What had once been considered inherently obvious is no longer to be taken for granted. In this review we will focus on some of the controversies surrounding various aspects of the pharmacologic treatment regimens for patent ductus arteriosus closure. The pros and cons of prophylactic vs therapeutic indomethacin, of early vs late therapy, of high- vs low-dose indomethacin, of single vs multiple courses of treatment, and of ibuprofen vs indomethacin will be considered. In addition, the possibility that patency of the ductus arteriosus is merely a physiological manifestation of extreme prematurity, and thus does not necessarily need to be therapeutically closed, has become a viable approach in some cases. As such, we will examine echocardiographic and biochemical criteria aimed at determining the clinical and hemodynamic significance of ductal shunting, and thereby of the need to treat. Finally, we speculate on potential therapeutic directions for the future, including individualized treatment regimens and multidrug treatment cocktails for those who fail initial monodrug therapy.
authors.affiliation: Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel. cathy@cc.huji.ac.il
authors.forename: Cathy
authors.initials: C
authors.lastname: Hammerman
authors.forename: Alona
authors.initials: A
authors.lastname: Bin-Nun
authors.forename: Michael
authors.initials: M
authors.lastname: Kaplan
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D015415:Biomarkers / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D007213:Indomethacin / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D020097:Natriuretic Peptide, Brain; D009419:Nerve Tissue Proteins / Q000378:metabolism; D057285:Precision Medicine; D011247:Pregnancy; D013997:Time Factors
chemical_list: D015415:Biomarkers; D009419:Nerve Tissue Proteins; C095026:brain natriuretic peptide-35, rat; D020097:Natriuretic Peptide, Brain; D000082:Acetaminophen; D007052:Ibuprofen; D007213:Indomethacin