AAP Releases Updated Guidelines for Assessing and Treating Patent Ductus Arteriosus in Preterm Infants

In the latest issue of Pediatrics, the American Academy of Pediatrics (AAP) has issued revised guidance on how to evaluate and manage patent ductus arteriosus (PDA) in premature newborns. The guideline, authored by Dr. Namasivayam Ambalavanan and colleagues from the University of Alabama at Birmingham, highlights that delayed closure of PDA is common among preemies, especially the more immature infants. Echocardiography remains a key tool to confirm the presence of PDA and to determine its impact on heart function.

When a PDA is deemed hemodynamically significant (hsPDA), pharmacologic interventions such as ibuprofen or acetaminophen can be used to promote closure. Recent research indicates that early or prophylactic treatment does not confer additional benefits compared to expectant management, leading to the recommendation against routine early closure within the first two weeks of life.

Management beyond the initial two weeks is less clearly defined due to insufficient evidence. Clinicians often consider transcatheter or surgical closure if the PDA persists despite medical therapy or if drug treatment is contraindicated. The use of surgical ligation has decreased, with transcatheter closure becoming more prevalent in many centers.

The authors emphasize the need for more research and trials to better understand treatment benefits and risks, advocating for parental support and shared decision-making during management. They stress that current evidence does not definitively favor any approach, underscoring the importance of individualized care and further studies.

This new guidance aims to assist clinicians in making informed decisions tailored to each preterm infant’s condition, ensuring optimal outcomes.

Source: medicalxpress.com