TY - JOUR
T1 - Patent ductus arteriosus in preterm infants, part 1
T2 - Understanding the pathophysiologic link between the patent ductus arteriosus and clinical complications
AU - Elsayed, Yasser N.
AU - Fraser, Debbie
PY - 2017
Y1 - 2017
N2 - The clinical guidelines for treating patent ductus arteriosus (PDA) have significantly evolved over the last decades from treating any ductal shunt to more conservative management where only the hemodynamically significant patent ductus arteriosus (HSPDA) is treated. This shift has resulted largely from a lack of evidence from randomized controlled trials supporting a relationship between treating a PDA and improving long-term neonatal outcomes. However, there are many unresolved issues. There is no consensus on the precise definition of HSPDA requiring treatment or a clear understanding of when to treat HSPDA. Moreover, the current evidence shows worsening of the long-term neurodevelopmental outcome for infants undergoing surgical PDA ligation. The presence of physiologic variability among preterm infants, and the presence of different compensatory mechanisms may make it difficult to establish a link between pathophysiology and longterm outcomes. That is, the physiologic variability cannot be simply assessed by randomly assigning infants into two arms of a study. Relying on research from animal and human studies, this article explains the link between the pathophysiology of a PDA and neonatal outcomes. 2017 Springer Publishing Company.
AB - The clinical guidelines for treating patent ductus arteriosus (PDA) have significantly evolved over the last decades from treating any ductal shunt to more conservative management where only the hemodynamically significant patent ductus arteriosus (HSPDA) is treated. This shift has resulted largely from a lack of evidence from randomized controlled trials supporting a relationship between treating a PDA and improving long-term neonatal outcomes. However, there are many unresolved issues. There is no consensus on the precise definition of HSPDA requiring treatment or a clear understanding of when to treat HSPDA. Moreover, the current evidence shows worsening of the long-term neurodevelopmental outcome for infants undergoing surgical PDA ligation. The presence of physiologic variability among preterm infants, and the presence of different compensatory mechanisms may make it difficult to establish a link between pathophysiology and longterm outcomes. That is, the physiologic variability cannot be simply assessed by randomly assigning infants into two arms of a study. Relying on research from animal and human studies, this article explains the link between the pathophysiology of a PDA and neonatal outcomes. 2017 Springer Publishing Company.
KW - Neonatal outcomes
KW - Neonatal pathophysiology
KW - Patent ductus arteriosus
KW - Preterm infants
UR - http://www.scopus.com/inward/record.url?scp=85028376140&partnerID=8YFLogxK
U2 - 10.1891/0730-0832.36.5.265
DO - 10.1891/0730-0832.36.5.265
M3 - Journal Article
C2 - 28847349
AN - SCOPUS:85028376140
SN - 0730-0832
VL - 36
SP - 265
EP - 272
JO - Neonatal network : NN
JF - Neonatal network : NN
IS - 5
ER -