Neonatology Today

There is limited consensus on the diagnosis and management of a patent ductus arteriosus (PDA) in preterm neonates. PDA remains one of the most common cardiovascular abnormalities in preterm neonates occurring in about a third of infants below 30 weeks gestation and up to 60% of infants less than 28 weeks. Shunting from the systemic to the pulmonary circulations, oftentimes referred to as ductal steal, results in systemic hypoperfusion and pulmonary overcirculation with end-organ morbidity. Infants are usually referred for surgical ligation following failure of successful treatment or in the presence of contraindications. The decisions relating to selection for and the timing of referral for surgical ligation remain controversial. In addition, the inherent shortand long-term risks associated with PDA ligation are becoming increasingly recognized. As a result, there is a current shift in opinion and a reluctance to refer infants for the procedure. This article describes the physiological changes occurring before, during, and after PDA ligation; we explore the relationship of these changes to shortand long-term clinical observations in the ligation population. A suggested management approach and future research directions are also discussed.