Confusion and rethinking in management of arterial ductus arteriosus in preterm infants

doi:10.3877/cma.j.issn.1673-5250.2024.06.001

Patent ductus arteriosus（PDA）is a common complication in premature infants.The questions of whether to close it，when to close it，and how to close it have been the focal point of debate in the field of neonatology.Based on the monograph "Confusion andThinking in the Management of Patent Ductus Arteriosus in Preterm Infants"written in 2016，the authors intend to give an overview of the classification of PDA in premature infants and the overall trend of PDA management strategies in premature infants，the main current treatment methods for PDA in premature infants，and the indications for active clinical measures to close hemodynamically significant PDA （Hs-PDA）.Combined with the current research progress at home and abroad，the author further discusses the confusion in the management of PDA in premature infants after rethinking，aiming to be helpful for the clinical practice of PDA in premature infants.

Key words: Ductus arteriosus，patent, Hemodynamically significant patent ductus arteriosus, Practice management，medical, Intervention studies, Thinking, Bronchopulmonary dysplasia, Conservative treatment, Infant，newborn

［1］	Maron JL.Patent ductus arteriosus-to close or not to close？［J］.N Engl J Med，2024，390（4）：370-371.DOI：10.1056/NEJMe2313738.
［2］	Cambonie G，Masson F，Mesnage R，et al.Management of patent ductus arteriosus in preterm infants：abundant literature，low certainty of evidence for clinicians［J］.Arch Pediatr，2024，31（8）：473-479.DOI：10.1016/j.arcped.2024.10.001.
［3］	Benitz WE，Backes CH.At a crossroads for early medical treatment of persistent patent ductus arteriosus in preterm infants［J］.J Perinatol，2024，44（10）：1534-1537.DOI：10.1038/s41372-024-02022-1.
［4］	de Klerk J，Engbers A，van Beek F，et al.Spontaneous closure of the ductus arteriosus in preterm infants：a systematic review［J］.Front Pediatr，2020，8：541.DOI：10.3389/fped.2020.00541.
［5］	Hamrick S，Sallmon H，Rose AT，et al.Patent ductus arteriosus of the preterm infant［J］.Pediatrics，2020，146（5）：e20201209.DOI：10.1542/peds.2020-1209.
［6］	李秋平，封志纯.早产儿动脉导管未闭管理中的困惑与思考［J］.中华儿科杂志，2016，54（1）：3-5.DOI：10.3760/cma.j.issn.0578-1310.2016.01.002.Li QP，Feng ZC.Confusion and thinking in the management of patent ductus arteriosus in preterm infants［J］.Chin J Pediatr，2016，54（1）：3-5.DOI：10.3760/cma.j.issn.0578-1310.2016.01.002.
［7］	Shepherd JL，Noori S.What is a hemodynamically significant PDA in preterm infants？［J］.Congenit Heart Dis，2019，14（1）：21-26.DOI：10.1111/chd.12727.
［8］	Johns Hopkins All Children's Hospital.Diagnosis and management of patent ductus arteriosus in preterm neonates clinical pathway［EB/OL］.（2023-11）［2024-10-19］.https：//www.hopkinsmedicine.org/-/media/files/allchildrens/clinicalpathways/pdapathway-11 _ 22 _ 2023.pdf？ openpdf =1.2025.1.19.
［9］	Kluckow M，Lemmers P.Hemodynamic assessment of the patent ductus arteriosus：beyond ultrasound［J］.Semin Fetal Neonatal Med，2018，23（4）：239-244.DOI：10.1016/j.siny.2018.04.002.
［10］	Mitra S，de Boode WP，Weisz DE，et al.Interventions for patent ductus arteriosus（PDA）in preterm infants：an overview of cochrane systematic reviews［J］.Cochrane Database Syst Rev，2023，4（4）：CD013588.DOI：10.1002/14651858.CD013588.pub2.
［11］	Woodford S，Parmar T，Leong E，et al.International online survey on the management of patent ductus arteriosus［J］.Neonatology，2024，121（3）：298-304.DOI：10.1159/000535121.
［12］	Abu-Shaweesh JM，Almidani E.PDA：does it matter？［J］.Int J Pediatr Adolesc Med，2020，7（1）：9-12.DOI：10.1016/j.ijpam.2019.12.001.
［13］	Hundscheid T，Onland W，Kooi E，et al.Expectant management or early ibuprofen for patent ductus arteriosus［J］.N Engl J Med，2023，388（11）：980-990.DOI：10.1056/NEJMoa2207418.
［14］	Gupta S，Subhedar NV，Bell JL，et al.Trial of selective early treatment of patent ductus arteriosus with ibuprofen［J］.N Engl J Med，2024，390（4）：314-325.DOI：10.1056/NEJMoa2305582.
［15］	Duboue PM，Padovani P，Bouteiller XP，et al.Post-ligation cardiac syndrome after surgical versus transcatheter closure of patent ductus arteriosus in low body weight premature infants：a multicenter retrospective cohort study［J］.Eur J Pediatr，2024，183（5）：2193-2201.DOI：10.1007/s00431-024-05481-y.
［16］	Sathanandam SK，Gutfinger D，O'Brien L，et al.Amplatzer piccolo occluder clinical trial for percutaneous closure of the patent ductus arteriosus in patients ≥700 grams［J］.Catheter Cardiovasc Interv，2020，96（6）：1266-1276.DOI：10.1002/ccd.28973.
［17］	Shah ZS，Clark RH，Patt HA，et al.Trends in procedural closure of the patent ductus arteriosus among infants born at 22 to 30 weeks'gestation［J］.J Pediatr，2023，263：113716.DOI：10.1016/j.jpeds.2023.113716.
［18］	Melchior C，Neves GR，de Oliveira BL，et al.Percutaneous closure of patent ductus arteriosus versus surgical treatment in low-birth-weight preterms：a systematic review and metaanalysis［J］.Cardiol Young，2024，34（4）：705-712.DOI：10.1017/S1047951123004353.
［19］	Orb Q，Dunya G，Padia R，et al.Long-term outcomes of vocal fold paralysis following patent ductus arteriosus ligation in neonates［J］.Laryngoscope，2023，133（5）：1257-1261.DOI：10.1002/lary.30343.
［20］	Bjorkman KR，Miles KG，Bellew LE，et al.Patent ductus arteriosus and lung magnetic resonance imaging phenotype in moderate and severe bronchopulmonary d ysplasia-pulmonary hypertension［J］.Am J Respir Crit Care Med，2024，210（3）：318-328.DOI：10.1164/rccm.202310-1733OC.
［21］	Li Q，Han T，Yang Y，et al.Age at surgical ligation of patent ductus arteriosus affects prognosis in extremely premature infants［J］.Iran J Pediatr，2022，32（1）：e115751.DOI：10.5812/ijp.115751.

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