title: The role of patent ductus arteriosus and its treatments in the development of bronchopulmonary dysplasia.
abstract: A persistent left-to-right shunt through a patent ductus arteriosus (PDA) increases the rate of hydrostatic fluid filtration into the lung's interstitium, impairs pulmonary mechanics, and prolongs the need for mechanical ventilation. In preclinical trials, pharmacologic PDA closure leads to improved alveolarization and minimizes the impaired postnatal alveolar development that is the pathologic hallmark of the "new bronchopulmonary dysplasia (BPD)". Although early pharmacologic closure of the PDA decreases the incidence of pulmonary hemorrhage, intraventricular hemorrhage, and the need for PDA ligation, there is little evidence from controlled, clinical trials to support or refute a causal role for the PDA in the development of BPD. However, evidence from epidemiologic, preclinical, and randomized controlled clinical trials demonstrate that early ductus ligation is an independent risk factor for the development of BPD and may directly contribute to the neonatal morbidities it is trying to prevent.
authors.affiliation: Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA. clymanr@peds.ucsf.edu
authors.forename: Ronald I
authors.initials: RI
authors.lastname: Clyman
mesh_terms: D000818:Animals; D001997:Bronchopulmonary Dysplasia / Q000209:etiology*; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D004195:Disease Models, Animal; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use*; D007231:Infant, Newborn; D007234:Infant, Premature; D011652:Pulmonary Circulation; D012121:Respiration, Artificial / Q000009:adverse effects
chemical_list: D016861:Cyclooxygenase Inhibitors; D007052:Ibuprofen