Title:Principles of Clinical Management of Patent Ductus Arteriosus in Extremely Preterm Neonates
Volume: 12
Issue: 2
Author(s): Zhen Han Tan and Vijay R. Baral
Affiliation:
Keywords:
Acetaminophen, cyclooxygenase, indomethacin, ibuprofen, preterm newborns, patent ductus arteriosus.
Abstract: The clinical management of a patent ductus arteriosus (PDA) in preterm newborns is a controversial
topic, and despite nearly three decades of research, varying opinions remain. This dilemma
stems from uncertain causal linkage between PDA and neonatal comorbidities, as well as the lack of
clear evidence showing that benefits of treatment outweigh risks. There has been a general shift in the
management of PDA in preterm newborns from early and aggressive closure to a more conservative
approach of watchful waiting and spontaneous closure. However, a firm recommendation cannot be
made due to a lack of randomized controlled trials validating either treatment strategies. Although cyclooxygenase inhibitors,
namely indomethacin and ibuprofen, are approved pharmacological treatments for PDA, there is a need to explore alternative
medical therapies in view of lack of clinical response in many newborns and concerns over adverse effects. One
such recent interest is the use of acetaminophen as a pharmacological agent. This present review tries to address the questions
at hand, integrate the current evidence, highlight the principles of PDA management in preterm newborns, and suggest
areas for possible future research.
