| Patent ductus arteriosus of the preterm infant. | |
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MedLine Citation:
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PMID: 20421261 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Shannon E G Hamrick; Georg Hansmann |
Publication Detail:
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Type: Journal Article; Review Date: 2010-04-26 |
Journal Detail:
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Title: Pediatrics Volume: 125 ISSN: 1098-4275 ISO Abbreviation: Pediatrics Publication Date: 2010 May |
Date Detail:
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Created Date: 2010-05-03 Completed Date: 2010-05-18 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376422 Medline TA: Pediatrics Country: United States |
Other Details:
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Languages: eng Pagination: 1020-30 Citation Subset: AIM; IM |
Affiliation:
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Department of Pediatrics, Emory University, Atlanta, Georgia, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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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