Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.
Department of Neonatology, The Rotunda Hospital, Dublin, Ireland,
Neonatology. 2020;117(2):225-232. doi: 10.1159/000506988. Epub 2020 May 25.
Optimum management of the patent ductus arteriosus (PDA) in preterm infants remains one of the most debated topics within the field of neonatology. Despite numerous observational studies and over 60 randomized control trials, consensus on PDA management remains elusive. In order to make meaningful progress on the controversial issue of PDA management, several key factors must be thoroughly addressed; namely (1) accurate identification of infants at greatest risk of long-term morbidities from PDA exposure, (2) acceptance that the PDA is not a dichotomous entity and an individualised approach to its management is required for each neonate, (3) international consensus on what constitutes a haemodynamically significant PDA and (4) the incorporation of multi-organ assessment when evaluating the impact a PDA may pose on overall neonatal physiology. This review assesses the evidence base available supporting various therapeutic strategies for PDA, the deficits in our current knowledge on the definition of haemodynamic significance and future directions to pursue in order to more successfully address this contentious subject.
早产儿动脉导管未闭（PDA）的最佳管理仍然是新生儿学领域最具争议的话题之一。尽管有许多观察性研究和 60 多项随机对照试验，但对 PDA 管理的共识仍然难以达成。为了在有争议的 PDA 管理问题上取得有意义的进展，必须彻底解决几个关键因素；即（1）准确识别出因 PDA 暴露而面临长期并发症风险最大的婴儿，（2）接受 PDA 不是一个二元实体，需要为每个新生儿制定个体化的管理方法，（3）就什么构成血流动力学显著的 PDA 达成国际共识，以及（4）在评估 PDA 对整体新生儿生理学可能产生的影响时纳入多器官评估。这篇综述评估了支持 PDA 各种治疗策略的现有证据基础，以及我们目前在血流动力学意义定义方面的知识缺陷，并探讨了未来的研究方向，以更成功地解决这个有争议的问题。
