PATENT DUCTUS-ARTERIOSUS IN PREMATURE-INF ANTS - LITERATURE-REVIEW

The diagnosis of patent ductus arteriosus (PDA) is crucial in the neon atal period since this defect is present in 40% of preterm infants wit h respiratory distress. In patients with a clinical suspicion of PDA, Doppler studies should be done to evaluate the hemodynamic impact of t he shunt on the lungs, brain, kidneys, intestines, and heart. Rapid cl osure of the PDA should be obtained since the beneficial effects of th e shunt are rapidly cancelled out by negative effects associated with increased morbidity and mortality, including cardiocirculatory failure , hemorrhagic pulmonary edema, pulmonary hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, poor gastrointestinal tolerance to feeding, cerebral hemorrhage, and an increased length of the hospit al stay. Closure can be achieved by indomethacin therapy or surgery. I ndomethacin can be given either routinely as low-dose prophylactic the rapy started at birth or only to those infants with symptomatic PDA (4 0% of cases). The latter option may be preferable since indomethacin h as a number of adverse effects. Recent improvements and simplification s in surgical techniques have made surgery an excellent therapeutic al ternative.