Document Detail


Patent ductus arteriosus of the preterm infant.
MedLine Citation:
PMID:  20421261     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A persistently patent ductus arteriosus (PDA) in preterm infants can have significant clinical consequences, particularly during the recovery period from respiratory distress syndrome. With improvement of ventilation and oxygenation, the pulmonary vascular resistance decreases early and rapidly, especially in very immature infants with extremely low birth weight (<1000 g). Subsequently, the left-to-right shunt through the ductus arteriosus (DA) is augmented, thereby increasing pulmonary blood flow, which leads to pulmonary edema and overall worsening of cardiopulmonary status. Prolonged ventilation, with the potential risks of volutrauma, barotrauma, and hyperoxygenation, is strongly associated with the development and severity of bronchopulmonary dysplasia/chronic lung disease. Substantial left-to-right shunting through the ductus may also increase the risk of intraventricular hemorrhage, necrotizing enterocolitis, and death. Postnatal ductal closure is regulated by exposure to oxygen and vasodilators; the ensuing vascular responses, mediated by potassium channels, voltage-gated calcium channels, mitochondrial-derived reactive oxygen species, and endothelin 1, depend on gestational age. Platelets are recruited to the luminal aspect of the DA during closure and probably promote thrombotic sealing of the constricted DA. Currently, it is unclear whether and when a conservative, pharmacologic, or surgical approach for PDA closure may be advantageous. Furthermore, it is unknown if prophylactic and/or symptomatic PDA therapy will cause substantive improvements in outcome. In this article we review the mechanisms underlying DA closure, risk factors and comorbidities of significant DA shunting, and current clinical evidence and areas of uncertainty in the diagnosis and treatment of PDA of the preterm infant.
Authors:
Shannon E G Hamrick; Georg Hansmann
Publication Detail:
Type:  Journal Article; Review     Date:  2010-04-26
Journal Detail:
Title:  Pediatrics     Volume:  125     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-03     Completed Date:  2010-05-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1020-30     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatrics, Emory University, Atlanta, Georgia, USA.
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MeSH Terms
Descriptor/Qualifier:
Comorbidity
Ductus Arteriosus, Patent / diagnosis,  physiopathology,  therapy*
Evidence-Based Medicine
Humans
Infant, Extremely Low Birth Weight*
Infant, Newborn
Infant, Premature, Diseases / diagnosis,  physiopathology,  therapy*
Pulmonary Circulation / physiology
Respiratory Distress Syndrome, Newborn / diagnosis,  physiopathology
Risk Factors
Treatment Outcome
Vascular Resistance / physiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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