Management of the patent ductus arteriosus in preterm infants

Abstract

Management of the patent ductus arteriosus (PDA) is one of the most contentious topics in the care of preterm infants. PDA management can be broadly divided into prophylactic and symptomatic therapy. Prophylaxis with intravenous indomethacin in extremely low birth weight infants may reduce severe intraventricular hemorrhage. Echocardiography should be routinely used to confirm the presence of a PDA before considering symptomatic therapy. A symptomatic PDA can be managed conservatively, using pharmacotherapy or with procedural closure. Ibuprofen should be considered as the pharmacotherapy of choice for a symptomatic PDA. High-dose ibuprofen may be preferable, especially for preterm infants beyond the first 3 to 5 days of age. If pharmacotherapy fails (after two courses) or is contraindicated, procedural closure may be considered for infants with a persistent PDA with significant clinical symptoms in addition to echocardiographic signs of a large PDA shunt volume and pulmonary over-circulation.

CANADIAN PAEDIATRIC SOCIETY FETUS AND NEWBORN COMMITTEE (2020–2021)

Members: Gabriel Altit MD, Nicole Anderson MD (Resident Member), Heidi Budden MD (Board Representative), Leonora Hendson MD (past member), Souvik Mitra MD, Michael R. Narvey MD (Chair), Eugene Ng MD, Nicole Radziminski MD, Vibhuti Shah MD (past member)

Liaisons: Radha Chari MD (The Society of Obstetricians and Gynaecologists of Canada), James Cummings MD (Committee on Fetus and Newborn, American Academy of Pediatrics), William Ehman MD (College of Family Physicians of Canada), Danica Hamilton RN (Canadian Association of Neonatal Nurses), Chloë Joynt MD (CPS Neonatal-Perinatal Medicine Section Executive), Chantal Nelson PhD (Public Health Agency of Canada)

CANADIAN PAEDIATRIC SOCIETY DRUG THERAPY AND HAZARDOUS SUBSTANCES COMMITTEE (2020–2021)

Members: Jean-François Turcotte MD (Board Representative), Yaron Finkelstein MD, Shinya Ito, Geert ‘t Jong MD (Chair), Tom McLaughlin MD, Shahrad Rassekh MD, Smita Roychoudhury MD (Resident Member)

Liaison: Michael J. Rieder MD PhD (Canadian Society of Pharmacology and Therapeutics)

Principal authors: Souvik Mitra MD, MSc, Dany Weisz MD, Amish Jain MBBS, MRCPCH, PhD, Geert ‘t Jong MD

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