Hemodynamically Significant Patent Ductus Arteriosus (HsPDA) in a Preterm Infant – An Innocent Bystander or a Predilection for Disaster?

Excerpt

A hemodynamically significant patent ductus arteriosus (HsPDA) in a preterm infant remains an object of controversy as far as the decision for screening, treatment, and modality of treatment. The heart of the controversy is the fact that preterm PDA has been implicated in several clinical outcomes. These include chronic lung disease (CLD), necrotising enterocolitis (NEC), intraventricular haemorrhage (IVH), pulmonary haemorrhage and acute kidney injury (AKI) [1]. However, treatment of the HsPDA has not shown a reduction in any of these morbidities. This has been supported by the fact that conservative management with watchful expectancy has resulted in successful closure without adverse effects [2]. The trials on HsPDA, however, have had some limitations, namely the heterogeneity in the definition of HsPDA and lack of a standardized approach to measurable hemodynamic effects causing clinical instability [3]. The most common definitions of HsPDA use the size of the PDA in combination with one or more parameters of pulmonary over-circulation or systemic hypo-perfusion. The left atrium to aortic root ratio >1.4 with diastolic flow reversal in the abdominal aorta is the commonly used parameter. These parameters individually are not specific to a HsPDA and must be taken in combination and the best approach widely remains unknown. …