scholarly journals Patent Ductus Arteriosus: An Overview

2007 ◽  
Vol 12 (3) ◽  
pp. 138-146 ◽  
Author(s):  
James E. Dice ◽  
Jatinder Bhatia
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Congenital Heart ◽  
Heart Defects ◽  
Ductus Arteriosus ◽  
Clinical Signs ◽  
Medical Intervention ◽  
Fluid Restriction ◽  
Term Infants ◽  
Patent Ductus

Patent ductus arteriosus (PDA) is one of the most common congenital heart defects, accounting for 5%–10% of all congenital heart disease in term infants. The occurrence of PDA is inversely related to gestational age and weight, with an even greater incidence in preterm infants. The maintenance of ductal patency is essential for the normal development of the fetus. In the neonate, however, persistent patency of the ductus arteriosus (DA) is associated with significant morbidity and mortality. Normally, at birth, the DA constricts, resulting in intraluminal ischemic hypoxia, which eventually leads to closure and remodeling of the ductus. PDA in term infants is usually associated with a functional defect, whereas in preterm infants it is associated with immaturity. Normal physiologic mechanisms contributing to closure - oxygen tension and decreased prostaglandins—are altered in prematurity. Clinical signs of ductal patency include murmur, tachycardia, bounding peripheral pulses, and congestive heart failure and associated symptoms. Symptoms are not always present; therefore, diagnostic imaging is critical if a PDA is suspected on clinical grounds. Three management strategies are currently available for PDA: fluid restriction and diuretics (as clinically appropriate), medical intervention, and surgical ligation. Pharmacologic closure can be achieved via administration of intravenous indomethacin or ibuprofen lysine. While both agents have shown similar efficacy, ibuprofen lysine has demonstrated an improved safety profile, particularly in terms of renal effects, compared to indomethacin.

Clinical Pharmacology of Ibuprofen and Indomethacin in Preterm Infants with Patent Ductus Arteriosus

2014 ◽  
Vol 10 (3) ◽  
pp. 216-237 ◽  
Author(s):  
Gian Maria Pacifici
Keyword(s):  
Patent Ductus Arteriosus ◽  
Serum Creatinine ◽  
Prostaglandin E2 ◽  
Preterm Infants ◽  
Gestational Age ◽  
Urine Output ◽  
Ductus Arteriosus ◽  
Closure Rate ◽  
Term Infants ◽  
Patent Ductus

Background: Ibuprofen and indomethacin are potent non-selective cyclo-oxygenase inhibitors and inhibit prostaglandin E2 synthesis. The patent ductus arteriosus (PDA) occurs in more than 70% of preterm infants weighing <1500 g. Prostaglandin E2 relaxes smooth muscle, tends to inhibit the closure of PDA, yields vasodilatation of the afferent renal arterioles and maintains glomerular filtration rate (GFR). Ibuprofen and indomethacin inhibiting prostaglandin E2 synthesis close PDA and reduce GFR with consequent decrease of urine output and increase of serum creatinine concentrations. Aims: The aims of this study are to give the definitive estimates of PDA closure rate following ibuprofen or indomethacin treatment and to evaluate the extent of renal side effects following the administration of these drugs to preterm infants. Other aims are to review the metabolism and the pharmacokinetics of ibuprofen and indomethacin in preterm infants with PDA. Methods: The bibliographic search was performed using PubMed and EMBASE databases as search engines, January 2013 was the cutoff point. Results: The %PDA closed by ibuprofen (n=24) and indomethacin (n=24) is 77.7±14.1 and 77.3±11.0, respectively. For ibuprofen, the gestational age of the infants included in the study ranged from 25.0 to 39.0 weeks (mean±SD=29.3±3.1 weeks). The %PDA did not correlate with the gestational age (p=0.2516). For indomethacin, the gestational age of infants included in the study ranged from 25.0 and 39.0 weeks (mean±SD=29.4±2.9 weeks). The %PDA did not correlate with the gestational age (p=0.3742). The treatment with ibuprofen reduces the urine output and increases the serum creatinine concentrations less extensively than indomethacin. The half-life (t1/2) of ibuprofen and indomethacin is lengthened and the clearance is reduced in preterm infants as compared with fullterm infants. Conclusions. Ibuprofen and indomethacin are equally effective in closing PDA. Treatment with ibuprofen decreases the risk of renal failure. Ibuprofen has the most favourable risk/benefit ratio. The rate of metabolism is reduced and t1/2 is lengthened in prematures as compared with term infants.

Diagnosis and Management of Patent Ductus Arteriosus in Newborn: An Update

2021 ◽  
Vol 36 (1) ◽  
pp. 61-66
Author(s):  
Gazi Mohammad Imranul Haque ◽  
Probir Kumar Sarkar
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infant ◽  
Gestational Age ◽  
Medical Management ◽  
Ductus Arteriosus ◽  
Pharmacological Therapy ◽  
Fluid Restriction ◽  
Term Infants ◽  
Fetal Survival ◽  
Patent Ductus

Patent ductus arteriosus is one of the common congenital acyanotic heart disease in neonates, especially in preterm. Patent ductus arteriosus (PDA) is a congenital condition, characterized by a persistent connection between the aorta and the pulmonary artery. Patency of Ductus Arteriosus is essential for fetal survival. Patent ductus arteriosus is one of the most common clinical findings and most frequent source of complications in premature infant. After birth, in term infants, the ductus usually closes within the first day of life, starting with functional closure followed by anatomical closure with vascular remodeling. The persistence of the PDA in preterm infant is inversely related to gestational age and birth weight. The incidence of Patent Ductus Arteriosus is 31% in preterm infant weighing 501 to 1500 gm and gestational age 29 weeks. The treatment options available are conservative medical management, pharmacological therapy or surgical ligation. Conservative medical management involves fluid restriction; watchful waiting and ventilator support. DS (Child) H J 2020; 36(1) : 61-66

Hemodynamic Effects of Fluid Restriction in Preterm Infants with Significant Patent Ductus Arteriosus

2012 ◽  
Vol 161 (3) ◽  
pp. 404-408 ◽  
Author(s):  
Julie De Buyst ◽  
Thameur Rakza ◽  
Thomas Pennaforte ◽  
Anne-Britt Johansson ◽  
Laurent Storme
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Fluid Restriction ◽  
Hemodynamic Effects ◽  
Patent Ductus

scholarly journals Feasibility and Safety of Percutaneous Cardiac Interventions for Congenital and Acquired Heart Defects in Infants ≤1000 g

Children ◽  
2021 ◽  
Vol 8 (9) ◽  
pp. 826
Author(s):  
Ranjit Philip ◽  
Jeffrey Towbin ◽  
Neil Tailor ◽  
Vijaya Joshi ◽  
Jason N. Johnson ◽  
...  
Keyword(s):  
Adverse Event ◽  
Patent Ductus Arteriosus ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Transcatheter Closure ◽  
Heart Defects ◽  
Ductus Arteriosus ◽  
Major Adverse Event ◽  
Procedural Success ◽  
Patent Ductus

The transcatheter closure of patent ductus arteriosus (TCPC) has been demonstrated to be feasible even in infants weighing ≤1000 g. However, other percutaneous cardiac interventions (PCI) for such small infants born with congenital heart defects (CHD) or acquired heart defects (AHD) have not been well described. The purpose of this study was to describe the feasibility and safety of PCI in infants ≤1000 g. A retrospective review was conducted between June 2015 and May 2021, looking at 148 consecutive PCIs performed on infants weighing ≤1000 g at the time of the procedure. The procedural success rate was 100%. The major adverse event (AE) rate for TCPC was 3%, while there were no major AEs for other PCI. It is feasible to perform PCIs in infants weighing ≤1000 g with CHD and AHD using currently available technologies.

scholarly journals Intravenous Indomethacin Therapy in Infants With a Patent Ductus Arteriosus Complicating Other Congenital Heart Defects

2003 ◽  
Vol 67 (9) ◽  
pp. 750-752 ◽  
Author(s):  
Ken Watanabe ◽  
Hideshi Tomita ◽  
Yasuo Ono ◽  
Osamu Yamada ◽  
Ken-ichi Kurosaki ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Ductus Arteriosus ◽  
Patent Ductus
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