Contemporary Perspectives on the Patent Ductus Arteriosus in Preterm Neonates: A Hemodynamics-Driven Approach

The association of a patent ductus arteriosus (PDA) with significant morbidity and mortality among preterm neonates is well known. Despite decades of human and animal experimental investigations, the optimal approach to management remains largely unknown and controversial. 

The results of major clinical trials have contributed to a pendulum swing towards PDA non-intervention; yet researchers and clinicians are limited by several major methodological flaws, of which failure to adjudicate hemodynamic significance is the most problematic. While pharmacotherapy remains the first-line treatment for a presumed pathologic PDA, the recent advent and rapid expansion of percutaneous catheter-based definitive closure over the past decade is changing practice. The growth of the field of neonatal hemodynamics and use of targeted neonatal echocardiography (TnECHO) has facilitated enhanced quantification of PDA shunt volume via a comprehensive, standardized, and multi-parametric approach.

Herein, we provide a contemporary review of the challenges inherent in the current state of PDA management and the opportunity provided by a hemodynamics-driven approach to optimize the diagnosis, targeted management, and (if needed) the post-percutaneous interventional care of a hemodynamically-significant PDA.