DUCTUS ARTERIOSUS PERSISTENS IN PRETERM INFANTS - CONTROVERSIES OF THERAPEUTIC APPROACH AND ASSOCIATED COMORBIDITIES: A REVIEW ARTICLE

Abstract

The ductus arteriosus (DA) is a vascular structure that plays a crucial role in the fetal blood flow pattern. Its closure occurs in
the first hours or days of life in most full-term children, but in premature infants, it can remain open for several weeks or months after birth, with different clinical significance, ranging from a physiological state to a burdensome, pathological state with significant repercussions on the pulmonary and systemic circulation, and it can be associated with numerous comorbidities. Open DA in preterm infants is the most common cardiac condition in this population, and it is the subject of many studies and researches. Heterogeneity in the results of research into ductal shunt problems has led to different clinical approaches and treatment protocols,
from prophylactic, early pharmacological treatment of asymptomatic ductus, therapeutic treatment of symptomatic ductus, surgical ligation, to protocols of careful monitoring, “watchful waiting” and conservative approach. The greatest controversy surrounding the approach to this problem stends from the fact that reliable clinical and echocardiographic markers that would be sufficiently informative for the diagnosis of hemodynamically significant ductal shunt in premature infants during the first days of life have not
yet been identified. Therefore, there is disagreement regarding the therapeutic approach, especially timely treatment, or “timing of ductal shunt”.