Current approaches to the patent ductus arteriosus: Implications for pulmonary morbidities

Abstract

The natural closure of the ductus arteriosus is often delayed in premature newborns, especially in the most immature ones, and a significant left-to-right shunt volume raises concerns about pulmonary overcirculation, steal of systemic blood flow, and its potential contribution to neonatal respiratory morbidities such as bronchopulmonary dysplasia (BPD). Extremely low gestational age and long duration of mechanical ventilation may influence the relationship between the patent ductus arteriosus (PDA) and BPD. Decades of research has employed various pharmacologic approaches including NSAIDs and acetaminophen administered based on diverse criteria and using various timing, dose, and route combinations. Unfortunately, none of these interventions has consistently demonstrated meaningful improvements in clinical outcomes. Instead, these treatments inconsistently achieve PDA closure or restriction of flow through the ductus and are often associated with adverse effects. Thus, the lack of clear benefit from available treatments, coupled with the potential for harm, has prompted many centers to adopt conservative or expectant management of the PDA while awaiting novel strategies that could offer improved efficacy and safety. This review explores the associations between PDA and pulmonary outcomes of prematurity, reflecting on past research and outlining potential future directions.