Patent ductus arteriosus medical therapy in preterm babies


 * Associate Editor-In-Chief: Priyamvada Singh, M.B.B.S. [mailto:psingh@perfuse.org], ; Assistant Editor-In-Chief: Kristin Feeney, B.S. [mailto:kfeeney@perfuse.org]

Overview
Prostaglandin E2 plays a key role in maintaining the patency of ductus arteriosus before birth. Thus, prostaglandin E2 inhibitors are used as a therapeutic options to close the patent ductus arteriosus.

Medical therapy
In term infants the ductus closure occur by 24 hours of bith in 50% of babies, by 48 hours in 90% of babies and by 72 hours in most of them. However, the ductal closure is delayed in preterm infants.

Ductal constriction occurs after birth due to following reasons-
 * The increased oxygen tension after birth with onset of breathing
 * Decreased prostaglandin E2 due to removal of placenta
 * Increased removal of prostaglandin E2 from lung

Medical therapy
 * Prostaglandin E2 has been found to play a key role in maintaining the patency of ductus arterisus(DA)in the fetal life. Thus, use of inhibitors of prostaglandin synthesis (eg, indomethacin and ibuprofen) have been found to be effective in the treatment of PDA. These drugs were also found to be useful in ductus closure if given antenatally.Patients with cases involving the transposition of the great vessels (TGV) may need the ductus arteriosus kept open with prostaglandin E1 (PGE1).
 * Steroids like hydrocortisone have been found to decrease the sensitivity of ductus to PGE2.Thus, facilitating ductal constriction.
 * Nitic oxide synthesized from endothelial cells have been shown to cause ductus constriction in animal studies.

==ACC/AHA recommendations for medical therapy in patients with patent ductus arteriosus (DONOT EDIT)==

Class I

1. Routine follow-up is recommended for patients with a small PDA without evidence of left-sided heart volume overload. Follow-up is recommended every 3 to 5 years for patients with a small PDA without evidence of left-heart volume overload. (Level of Evidence: C)

Class III

1. Endocarditis prophylaxis is not recommended for those with a repaired PDA without residual shunt. (Level of Evidence: C) For ACC/AHA Level of evidence and classes click:ACC AHA Guidelines Classification Scheme