title: Patent Ductus Arteriosus in the Preterm Infant: Diagnostic and Treatment Options.
abstract: BACKGROUND
  The incidence of hemodynamically significant patent ductus arteriosus (hsPDA) increases with decreasing gestational age and is associated with many common morbidities of extreme prematurity. Controversies remain surrounding the definition of hsPDA, the population of infants requiring treatment, the appropriate timing and method of treatment, and the outcomes associated with PDA and its therapies.
  
  
  OBJECTIVE
  This integrative literature review focuses on diagnostic and treatment recommendations derived from the highest levels of evidence.
  
  
  METHODS
  PubMed and CINAHL were searched using key words "neonatal" and "patent ductus arteriosus" to discover the highest levels of evidence surrounding diagnosis, treatment methods, and outcomes.
  
  
  RESULTS
  The lack of consensus surrounding the diagnosis and clinical significance of PDA hinders meta-analysis across studies and confounds understanding of appropriate management strategies. Novel biomarkers, pharmaceutical choices, and transcatheter closure methods are expanding diagnostic and treatment options.
  
  
  CONCLUSIONS
  Infants weighing less than 1000 g are at highest risk. Prophylactic closure is no longer recommended, although early asymptomatic therapy is still preferred by some to avoid prolonged pulmonary overcirculation or decreased renal and gut perfusion. Conservative treatment measures such as fluid restriction and diuretic administration have not consistently proven effective and are in some instances detrimental. Cyclooxygenase inhibitors are effective but have adverse renal and mesenteric effects. Oral ibuprofen is associated with lower instance of necrotizing enterocolitis.
  
  
  CONCLUSIONS
  Well-defined staging criteria would aid in comparison and meta-analysis. Trials that include a control group that receives no therapy may help separate the outcomes associated with prematurity from those associated with PDA.
authors.affiliation: University of Virginia School of Nursing, Charlottesville (Ms Prescott and Dr Keim-Malpass); and Fairfax Neonatal Associates, Inova Children's Hospital, Fairfax, Virginia (Ms Prescott).
authors.forename: Stephanie
authors.initials: S
authors.lastname: Prescott
authors.forename: Jessica
authors.initials: J
authors.lastname: Keim-Malpass
mesh_terms: D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization; D000072700:Conservative Treatment; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D004374:Ductus Arteriosus, Patent / Q000097:blood / Q000000981:diagnostic imaging / Q000628:therapy*; D004452:Echocardiography; D020345:Enterocolitis, Necrotizing / Q000139:chemically induced; D005440:Fluid Therapy; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use*; D007213:Indomethacin / Q000627:therapeutic use*; D007231:Infant, Newborn; D007234:Infant, Premature; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D051437:Renal Insufficiency / Q000139:chemically induced; D055989:Septal Occluder Device
chemical_list: D015415:Biomarkers; D016861:Cyclooxygenase Inhibitors; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D007052:Ibuprofen; D007213:Indomethacin