Abu-Shaweesh Jalal M, Almidani Eyad
Department of Pediatrics, Cleveland Clinic Children's, Cleveland, OH, USA.
Department of Pediatrics, King Faisal Specialist Hospital& Research Center, Riyadh, Saudi Arabia.
Int J Pediatr Adolesc Med. 2020 Mar;7(1):9-12. doi: 10.1016/j.ijpam.2019.12.001. Epub 2019 Dec 3.
Management of persistent patent ductus arteriosus (PDA) continues to be a challenging issue. The attitude toward PDA has shifted in the opposite direction during the last 20 years, from advocating an aggressive and early closure toward a call for watchful observation. While persistent PDA may cause challenges in the medical management of preterm neonates secondary to volume overload, pulmonary edema or hemorrhage, hypotension, and impaired tissue perfusion, its contribution toward long-term neonatal morbidities including bronchopulmonary dysplasia (BPD), ROP, NEC, and NDI has not been substantiated. By advocating conservative management, it is clear now that the majority of the PDA cases show spontaneous closure and do not require treatment. However, there has not been agreement regarding what constitutes a hemodynamically significant PDA and when, if any, it should be targeted for treatment. With increasing concern regarding possible associated complications with PDA ligation, a new trend for transcatheter approach to PDA closure is expanding. In this review, we summarize current understanding of the pathophysiology, diagnosis, and management of PDA in preterm infants, and we make some recommendations regarding evidence-based approach.
持续性动脉导管未闭（PDA）的管理仍然是一个具有挑战性的问题。在过去20年里，对PDA的态度已转向相反方向，从主张积极早期关闭转变为呼吁密切观察。虽然持续性PDA可能会给早产新生儿的医疗管理带来挑战，继发于容量超负荷、肺水肿或出血、低血压以及组织灌注受损，但它对包括支气管肺发育不良（BPD）、视网膜病变（ROP）、坏死性小肠结肠炎（NEC）和神经发育障碍（NDI）在内的长期新生儿疾病的影响尚未得到证实。通过倡导保守治疗，现在很清楚，大多数PDA病例会自然闭合，不需要治疗。然而，对于什么构成血流动力学显著的PDA以及何时（如果需要的话）应针对其进行治疗，目前尚无共识。随着对PDA结扎可能相关并发症的日益关注，经导管闭合PDA的新趋势正在扩大。在本综述中，我们总结了目前对早产儿PDA病理生理学、诊断和管理的认识，并就基于证据的方法提出了一些建议。
