Patent ductus arteriosus management in premature neonates weighing 1000-2000 grams: A comparison of prophylactic closure, clinically-indicated closure, and supportive care

Problem: The patent ductus arteriosus (PDA) is an opening between the aorta and pulmonary arteries that fails to close after birth. This allows for a shunting of blood between the vessels and is associated with multiple health complications, including chronic lung disease (CLD) and necrotizing enterocolitis (NEC). This literature review was conducted to determine which methods are most advantageous for achieving closure, as well as the necessity of closure in the first place. Methods: Systematic literature review using the PubMed article database at the Weill Cornell Medical Library. Results: There is no clear consensus in the literature on the necessity of medical closure, nor on what treatment is most effective for achieving closure. However, cyclooxygenase (COX) inhibitors are successful at inducing PDA closure in over 67% of neonates and ibuprofen may be the most beneficial COX inhibitor to use. Prophylactic COX inhibitor treatment reduces the likelihood of intraventricular hemorrhage and is preferable to treatment after symptoms develop. Surgical ligation may only be indicated for neonates in whom closure by COX inhibitor treatment is unlikely. Finally, medical closure methods may not impact neonatal outcome or morbidities, and may only be indicated in neonates in whom spontaneous closure is unlikely to occur. Conclusions: There is a need for randomized controlled clinical trials to establish evidence-based protocol for PDA closure, including the necessity of treatment and the most beneficial methods for achieving closure.