"The PDA is necessary to support fetal life but typically closes shortly after birth in full-term infants. In premature infants, however, the blood vessel can remain open and may lead to complications, including chronic respiratory difficulties or bronchopulmonary dysplasia (BPD), a complication of other breathing conditions. Medications including indomethacin, ibuprofen, and acetaminophen can close the PDA, but prior research has not shown improved survival or reduced key morbidities of prematurity in patients that receive this treatment, Montoya said."
"The study found no significant difference in survival in preterm infants that received active treatment versus expectant management (regular monitoring without immediate treatment) to close the patent ductus arteriosus (PDA), a fetal blood vessel that connects the pulmonary artery and aorta. "Despite closing the ductus more often, medications did not improve the studied outcomes," said Cassandra Montoya, MD, assistant professor of Pediatrics in the Division of Neonatology and a co-author of the study."
Early pharmacologic treatment with acetaminophen, ibuprofen, or indomethacin in infants born between 22 and 28 weeks gestation with a detected PDA was compared to expectant management. A trial enrolled 482 infants from 33 U.S. hospitals. Medications closed the ductus more often but did not improve survival or reduce major prematurity morbidities. Routine early pharmacologic PDA closure did not improve outcomes and may cause harm. PDA normally closes after birth but can remain open in preterm infants, increasing risk of chronic respiratory problems and bronchopulmonary dysplasia. Clinical practice varies widely across NICUs, creating the need for rigorous evidence to guide PDA management.
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