Materiały źródłowe

• #1 Patent ductus arteriosus (PDA) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/patent-ductus-arteriosus/diagnosis-treatment/drc-20376150

  Treatments for patent ductus arteriosus (PDA) depend on the age of the person being treated. […] Some people with small PDAs may only need regular health checkups to watch for complications. A premature baby born with patent ductus arteriosus also needs regular checkups to make sure the opening closes. […] A premature baby born with patent ductus arteriosus (PDA) may get medicines called nonsteroidal anti-inflammatory drugs. These medicines, also called NSAIDs, block certain body chemicals that keep the PDA open. However, these medicines won’t close a PDA in full-term babies, children or adults. […] Treatments to close a patent ductus arteriosus include: […] Using a thin tube called a catheter and a plug or coil to close the opening. This treatment is called a catheter procedure. It lets a doctor repair the opening without open-heart surgery.

• #1 Patent Ductus Arteriosus (PDA) – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/congenital-cardiovascular-anomalies/patent-ductus-arteriosus-pda

  Patent ductus arteriosus (PDA) is a persistence of the fetal connection (ductus arteriosus) between the aorta and pulmonary artery after birth. […] Administration of a cyclo-oxygenase inhibitor (ibuprofen lysine or indomethacin) with or without fluid restriction may be tried in preterm infants with a significant shunt, but this therapy is not effective in term infants or older children with PDA. […] Typical medical management of patent ductus arteriosus includes fluid restriction, a diuretic (usually a thiazide), maintenance of hematocrit 35 %, providing a neutral thermal environment, and, for ventilated patients, use of positive end-expiratory pressure (PEEP) to improve gas exchange. […] In preterm infants with a hemodynamically significant PDA and compromised respiratory status, the PDA can sometimes be closed by using a COX inhibitor (either ibuprofen lysine or indomethacin).

• #1 Diagnosis and Management of Patent Ductus Arteriosus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6269146/

  Preterm infants are at increased risk for patent ductus arteriosus (PDA). Prolonged exposure to PDA may be deleterious and has been associated with neonatal morbidity and mortality. […] This review discusses the evolving indications for treatment of a PDA and the various treatment options available. […] Some clinicians choose a prophylactic approach to indomethacin treatment, with a goal of preventing IVH, PDA, and the adverse consequences that have been associated with PDA in extremely low-birthweight infants. […] The indications for treatment of a symptomatic PDA include respiratory compromise (eg, requiring persistent mechanical support), heart failure, or large left-to-right ductus shunt with evidence of hemodynamic compromise, such as reversal of flow in the descending aorta during diastole, oliguria or rising serum creatinine concentration, hypotension, or wide pulse pressure.

• #1 Management of the patent ductus arteriosus in preterm infants | Canadian Paediatric Society

  https://cps.ca/documents/position/patent-ductus-arteriosus

  Selective prophylaxis with intravenous (IV) indomethacin may be considered in ELBW infants at high risk for severe IVH (conditional recommendation). There is insufficient evidence to recommend prophylactic ibuprofen or acetaminophen in extremely preterm or ELBW infants. […] Ibuprofen should be considered the pharmacotherapy of choice for a symptomatic PDA (strong recommendation). High-dose ibuprofen may be considered as the preferred dosage, especially for preterm infants beyond the first 3 to 5 days of age (conditional recommendation). Exercise caution when treating extremely preterm infants (26 weeks GA) with high-dose ibuprofen due to limited safety and efficacy data. […] A second course of COX-I therapy should be considered over invasive management for a persistent, symptomatic PDA when there are no contraindications (strong recommendation). The benefit of a third course of pharmacotherapy with enteral acetaminophen is unclear but may be considered after discussion with the infants parents or guardians, especially while awaiting invasive PDA closure (conditional recommendation).

• #1 Interventions for patent ductus arteriosus (PDA) in preterm infants: an overview of Cochrane Systematic Reviews – PubMed

  https://pubmed.ncbi.nlm.nih.gov/37039501/

  For treatment of symptomatic PDA, all available prostaglandin inhibitor drugs appear to be more effective in closing a PDA than placebo or no treatment (indomethacin: RR 0.30, 95% CI 0.23 to 0.38; 10 RCTs, 654 infants; high-certainty evidence; ibuprofen: RR 0.62, 95% CI 0.44 to 0.86; 2 RCTs, 206 infants; moderate-certainty evidence; early administration of acetaminophen: RR 0.35, 95% CI 0.23 to 0.53; 2 RCTs, 127 infants; low-certainty evidence). […] Oral ibuprofen appears to be more effective in PDA closure than intravenous (IV) ibuprofen (RR 0.38, 95% CI 0.26 to 0.56; 5 RCTs, 406 infants; moderate-certainty evidence). […] High-dose ibuprofen appears to be more effective in PDA closure than standard-dose ibuprofen (RR 0.37, 95% CI 0.22 to 0.61; 3 RCTs, 190 infants; moderate-certainty evidence).

• #1 Diagnosis and Management of Patent Ductus Arteriosus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6269146/

  In patients of more than 1,000 g birthweight with few risk factors, a PDA can generally be successfully managed conservatively, with modest fluid restriction and use of positive end expiratory pressure to treat pulmonary edema. […] Early use of indomethacin to close a PDA soon after birth (day 1-2 of age), compared with waiting 3 to 4 days after diagnosis, decreases the risk for pulmonary hemorrhage and IVH, and need for ligation. […] Three pharmacologic treatments are available to induce constriction of a PDA: indomethacin, ibuprofen, and acetaminophen (paracetamol). […] Acetaminophen has been used for rescue therapy after failed response to indomethacin in extremely premature infants, resulting in 46% of infants having a smaller or closed ductus. […] Surgical ligation is performed when a neonate has a hemodynamically significant PDA that results in cardiac dysfunction, renal failure, or respiratory failure. […] However, poor outcomes after PDA ligation may be overestimated by trial design, suggesting that surgical approaches deserve full consideration for infants with refractory, symptomatic PDA.

• #1 Patent Ductus Arteriosus – Pediatric Heart Specialists

  https://www.pediatricheartspecialists.com/view/76

  Physiologically, a PDA allows for oxygenated blood (red blood) to pass from the aorta backwards into the lungs. The effect is an increase in the total amount of blood that flows to the lungs. […] There is a wide spectrum of treatment options for a child or infant with a patent ductus arteriosus. Small PDAs detected in the first few days of life often close spontaneously. Even in cases where a small PDA remains open, specific therapy is often unnecessary. In children with larger PDAs who are symptomatic, medication may help those symptoms. The most commonly used medicine is furosemide (Lasix), a diuretic that works by decreasing excess lung fluid caused by the extra blood flow to the lungs. Furosemide may be given anywhere from 1 to 4 times daily. Side effects are uncommon; abnormalities of electrolytes can occasionally be seen with larger doses. Another medication frequently used in the setting of a large PDA is digoxin (Lanoxin). Digoxin increases calcium levels in heart cells, thereby improving overall heart function.

• #1 Patent Ductus Arteriosus (PDA) Treatment & Management: Approach Considerations, Conservative Management, Pharmacologic Management

  https://emedicine.medscape.com/article/891096-treatment

  Spontaneous closure of the patent ductus arteriosus (PDA) is common. If significant respiratory distress or impaired systemic oxygen delivery is present, therapy is usually prudent. Intravenous (IV) indomethacin (or the newer preparation of IV ibuprofen) is frequently effective in closing a PDA if it is administered in the first 10-14 days of life. Other options are catheter closure and surgical ligation, which entails a thoracotomy. […] Medical management also consists of amelioration of congestive heart failure (CHF) symptoms. CHF is an indication for closure of the PDA in infancy. If medical therapy is ineffective, urgent intervention to close the structure should be undertaken. […] All PDA should be closed because of the risk of bacterial endocarditis associated with the open structure. Over time, the increased pulmonary blood flow precipitates pulmonary vascular obstructive disease, which is ultimately fatal.

• #1 Patent Ductus Arteriosus (PDA): Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/17325-patent-ductus-arteriosus-pda

  Healthcare providers may treat PDA with surgical procedures, including: Cardiac catheterization: During cardiac catheterization, experts insert a thin, flexible tube (catheter) into the groin and thread it up through a blood vessel to the heart. They insert a plug or coil into the heart through the catheter to close the PDA and stop patent ductus arteriosus blood flow. Providers typically dont perform cardiac catheterization on premature babies, though older babies and children can have this procedure. Patent ductus arteriosus surgery: Surgeons make an incision in the side of the chest. They close the PDA with stitches (sutures) or a metal clip. […] After catheterization or surgery, blood flow returns to normal immediately if there are no other heart defects. […] Closing the PDA gets blood flow back to normal. After closure via a cardiac catheterization, your child will take antibiotics for six months to prevent heart infection (endocarditis). Your healthcare provider will discuss the necessary follow-up care with you.

• #1 Patent Ductus Arteriosus | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/patent-ductus-arteriosus

  The goal is to close the patent ductus arteriosus before the lungs become damaged from too much blood flow. In premature infants, medications may help close the patent ductus. These medications include indomethacin, ibuprofen, Tylenol, each working by stimulating the muscles inside the patent ductus arteriosus to tighten, closing the connection. […] In many cases your child’s patent ductus arteriosus may be repaired by a cardiac catheterization procedure. […] Recently, a new transcatheter device was approved by the FDA to close a patent ductus arteriosus in extremely low birth weight newborns, making it possible for many more patients to benefit from this minimally invasive procedure. […] Surgical repair (ligation) is recommended for children for whom a catheter-based procedure is not an option.

• #1 Patent Ductus Arteriosus (PDA) | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/p/patent-ductus-arteriosus-pda.html

  Patent ductus arteriosus (PDA) is a heart defect found in the days or weeks after birth. Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. A small PDA will often close on its own as your child grows. A PDA that causes symptoms will need to be treated with medicine, cardiac catheterization, or surgery. The cardiologist will check from time to time to see if the PDA is closing on its own. If a PDA does not close, it will be fixed to prevent lung problems. Treatment may include the following. […] Your baby may need medicines to help the heart work better. In premature infants, the medicine indomethacin may help close the PDA. It’s given through an IV (intravenous) line. Indomethacin stimulates the muscles inside the PDA to tighten. This closes the connection. Your child’s cardiologist can answer any questions you may have about this treatment.

• #1 Management of the patent ductus arteriosus among infants born at 23 to 32 weeks’ gestation between 2011 to 2022: a report from in the Children’s Hospitals Neonatal Consortium | Journal of Perinatology

  https://www.nature.com/articles/s41372-025-02257-6

  This study reports on patent ductus arteriosus (PDA) therapy trends across the Childrens Hospital Neonatal Consortium. […] Use of pharmacotherapy increased 44% (relative) over time, mostly with increased acetaminophen use. […] While the rate of definitive closure did not change, use of transcatheter PDA closure increased from 0 to 20.3% and surgical ligation decreased from 25.1% to 3.6%. […] There has been an increase in the use of multiple pharmacotherapies for PDA, especially among infants born 27 weeks gestation. […] Transcatheter PDA closure has overtaken surgical ligation as the primary method of definitive PDA closure. […] The management of the PDA in extremely premature infants at risk for cardiovascular compromise remains a long-standing clinical conundrum in the field of neonatology, but understanding contemporary trends of PDA care is a necessary step to filling in knowledge gaps.

• #1 Patent Ductus Arteriosus (PDA) Treatment & Management: Approach Considerations, Conservative Management, Pharmacologic Management

  https://emedicine.medscape.com/article/891096-treatment

  With rare exceptions, the presence of a patent ductus arteriosus (PDA) is an indication for surgical closure. […] Thus, indications for surgical treatment include the following: Failure of indomethacin treatment, Contraindications to medical therapy (eg, thrombocytopenia, renal insufficiency), Signs and symptoms of congestive heart failure (CHF), Patent ductus arteriosus (PDA) found in an older infant, Infants found to have an asymptomatic patent ductus arteriosus (PDA) after the neonatal period should undergo surgical ligation preferably before the age of 1 year to prevent future complications of a patent ductus arteriosus (PDA), Ductal closure is indicated for cardiovascular compromise (ie, pulmonary complications) and for reduction of the risk of infective endocarditis (subacute bacterial endocarditis).

• #1 Patent Ductus Arteriosus (PDA) | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/p/patent-ductus-arteriosus-pda.html

  Surgery can close PDAs. Surgical closure is often advised for babies younger than 6 months who have large defects and symptoms, such as poor weight gain and fast breathing. For babies who don’t have symptoms, any surgery may be delayed until after age 6 to 12 months. Your child’s cardiologist will advise when the surgery should be done. It is done under general anesthesia so your child will be asleep. Surgery closes the PDA with stitches or clips. This stops the extra blood from getting into the lungs. […] Most children with a fixed PDA will live normal, healthy lives.

• #1 Patent Ductus Arteriosus (PDA) Treatment & Management: Approach Considerations, Conservative Management, Pharmacologic Management

  https://emedicine.medscape.com/article/891096-treatment

  Although indomethacin therapy is preferred in most intensive care nurseries (NICUs) as the first-line approach to effect patent ductus arteriosus (PDA) closure, the benefits of this approach over surgical ligation are not obvious. […] A meta-analysis by Weisz et al did suggest that compared with pharmacologic treatment, surgical ligation for patent ductus arteriosus in preterm infants is associated with a reduced mortality rate but also with an increased morbidity risk. […] Complications of surgical ligation are mostly related to the left lateral thoracotomy. Surgical morbidity and mortality rates are negligible, and early postoperative complications are associated with other complications of prematurity. […] Typically, hospitalization following treatment for patent ductus arteriosus (PDA) is minimal. Patients who have catheter closure of patent ductus arteriosus (PDA) are usually sent home on the day of the procedure.

• #1 Patent Ductus Arteriosus | University of Michigan Health

  https://www.uofmhealth.org/conditions-treatments/ped-heart/conditions/patent-ductus-arteriosus

  Surgical results are also excellent. Surgery is the preferred treatment for a large PDA and/or if closure is required during infancy. It is done through a small incision between the ribs on the left side. The ductus is identified and either tied off or divided. Surgical complications are rare and include hoarseness or paralyzed diaphragm, infection, bleeding, and accumulation of fluid around the lungs. Most children go home two or three days after the surgery.

• #1 Patent Ductus Arteriosus (PDA): Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/17325-patent-ductus-arteriosus-pda

  Patent ductus arteriosus (PDA) is a heart condition that affects some babies (more often, those born prematurely). PDA sometimes resolves on its own. When it doesnt, healthcare providers treat PDA and restore normal circulation with medication, catheterization and surgery. […] Your healthcare provider will consider your babys age, size and health when determining a treatment plan. They might recommend observation (watchful waiting) to see if the PDA will close on its own. A watchful waiting approach involves regular checkups and tests so the provider can see if the PDA is closing. Occasionally, treatment may not be necessary. […] Healthcare providers may treat patent ductus arteriosus with medication, including nonsteroidal anti-inflammatory drugs (NSAIDs). Medications may encourage patent ductus arteriosus closure. This is commonly used in premature babies, but not in older children or adults.

• #1 Personalized Evidence-Based Management of Patent Ductus Arteriosus in Preterm Infants

  https://www.mdpi.com/2308-3425/11/1/7

  There is no universal consensus on management of patent ductus arteriosus (PDA) in preterm infants and it varies significantly worldwide, even among the clinicians within units. […] The authors propose a schematic targeted PDA treatment approach based on gestational and chronological age for practical clinical use, and they emphasize important future directions including advancement in PDA device closure techniques, diagnostic echo-parameters, hemodynamic evaluation to assess the impact on other organs, and understanding the long-term outcomes. […] Treatment options have also progressed over time. PDA was commonly treated with medications which have equivocal efficacy for its closure and/or with PDA ligation which have associated surgical complications. Recently, there has been an increase in treating PDA with percutaneous transcatheter closure in extremely preterm infants. PDA device closure has fewer adverse effects and better outcomes as compared to surgical ligation.

• #1 Patent ductus arteriosus (PDA) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/patent-ductus-arteriosus/diagnosis-treatment/drc-20376150

  Open-heart surgery to close the PDA. This treatment is called surgical closure. It may be needed if medicine doesn’t work or if the PDA is large or causing complications. […] Some people born with PDA need regular health checkups for life, even after treatment to close the opening. During these checkups, a healthcare professional may do tests to check for complications. Talk with your healthcare professional about your care plan. Ideally, it’s best to seek care from a doctor trained in treating adults with heart conditions before birth. This type of doctor is called a congenital cardiologist.

• #1 Patent Ductus Arteriosus | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/patent-ductus-arteriosus

  Most children with a patent ductus will live healthy lives after recovering from the repair. Their activity levels, appetite, and growth should return to normal. […] Our approach to the treatment of patent ductus at the Boston Children’s Hospital Benderson Family Heart Center is a carefully coordinated approach by multiple specialties. We offer treatments, including medical therapy, minimally invasive catheter-based interventions, and minimally invasive surgical solutions.

• #1 Management of the patent ductus arteriosus among infants born at 23 to 32 weeks’ gestation between 2011 to 2022: a report from in the Children’s Hospitals Neonatal Consortium | Journal of Perinatology

  https://www.nature.com/articles/s41372-025-02257-6

  The ongoing PIVOTAL randomized trial will provide higher level evidence addressing these outcomes. […] Our data suggest that availability of TCPC is growing rapidly at referral centers, but a lack of guidelines, long term outcome data, and persistent misconceptions about the procedure may cause some clinicians to be reluctant to refer patients for TCPC.

• #1 Management of the patent ductus arteriosus among infants born at 23 to 32 weeks’ gestation between 2011 to 2022: a report from in the Children’s Hospitals Neonatal Consortium | Journal of Perinatology

  https://www.nature.com/articles/s41372-025-02257-6

  In this multicenter, 12-year retrospective observational study of infants managed in CHNC NICUs, we identified a shift in the choice of definitive PDA closure from surgical ligation to TCPC. […] In addition, there were changes in pharmacotherapy including an overall increase in pharmacotherapy use in the most premature infants, increases in acetaminophen and multi-drug therapy, and a decrease in indomethacin use. […] The rapid adoption of TCPC over the study period in CHNC institutions has been balanced by the steady rates of overall definitive closure. […] TCPC use has grown, beginning in 2016, to 85% of definitive closures during epoch 4 while surgical ligation use has decreased from 100% of definitive closures in epoch 1 to 15% in epoch 4. […] The trends for definitive closure over the past decade have varied based on the years examined and the gestational ages of included infants.

• #2 Patent Ductus Arteriosus (PDA) Treatment & Management: Approach Considerations, Conservative Management, Pharmacologic Management

  https://emedicine.medscape.com/article/891096-treatment

  Spontaneous closure of the patent ductus arteriosus (PDA) is common. If significant respiratory distress or impaired systemic oxygen delivery is present, therapy is usually prudent. Intravenous (IV) indomethacin (or the newer preparation of IV ibuprofen) is frequently effective in closing a PDA if it is administered in the first 10-14 days of life. Other options are catheter closure and surgical ligation, which entails a thoracotomy. […] Medical management also consists of amelioration of congestive heart failure (CHF) symptoms. CHF is an indication for closure of the PDA in infancy. If medical therapy is ineffective, urgent intervention to close the structure should be undertaken. […] All PDA should be closed because of the risk of bacterial endocarditis associated with the open structure. Over time, the increased pulmonary blood flow precipitates pulmonary vascular obstructive disease, which is ultimately fatal.

• #2 Patent Ductus Arteriosus (PDA): Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/17325-patent-ductus-arteriosus-pda

  Patent ductus arteriosus (PDA) is a heart condition that affects some babies (more often, those born prematurely). PDA sometimes resolves on its own. When it doesnt, healthcare providers treat PDA and restore normal circulation with medication, catheterization and surgery. […] Your healthcare provider will consider your babys age, size and health when determining a treatment plan. They might recommend observation (watchful waiting) to see if the PDA will close on its own. A watchful waiting approach involves regular checkups and tests so the provider can see if the PDA is closing. Occasionally, treatment may not be necessary. […] Healthcare providers may treat patent ductus arteriosus with medication, including nonsteroidal anti-inflammatory drugs (NSAIDs). Medications may encourage patent ductus arteriosus closure. This is commonly used in premature babies, but not in older children or adults.

• #2 Management of the patent ductus arteriosus in preterm infants | Canadian Paediatric Society

  https://cps.ca/documents/position/patent-ductus-arteriosus

  Management of the patent ductus arteriosus (PDA) is one of the most contentious topics in the care of preterm infants. PDA management can be broadly divided into prophylactic and symptomatic therapy. Prophylaxis with intravenous indomethacin in extremely low birth weight infants may reduce severe intraventricular hemorrhage. Echocardiography should be routinely used to confirm the presence of a PDA before considering symptomatic therapy. A symptomatic PDA can be managed conservatively, using pharmacotherapy or with procedural closure. Ibuprofen should be considered as the pharmacotherapy of choice for a symptomatic PDA. High-dose ibuprofen may be preferable, especially for preterm infants beyond the first 3 to 5 days of age. If pharmacotherapy fails (after two courses) or is contraindicated, procedural closure may be considered for infants with a persistent PDA with significant clinical symptoms in addition to echocardiographic signs of a large PDA shunt volume and pulmonary over-circulation.

• #2 Patent Ductus Arteriosus (PDA) Treatment & Management: Approach Considerations, Conservative Management, Pharmacologic Management

  https://emedicine.medscape.com/article/891096-treatment

  Identification of additional cardiac malformations, such as coarctation or interrupted aortic arch or pulmonary atresia, is the most important requirement before pharmacologic or surgical closure of the PDA. When surgical ligation is not indicated, prostaglandin inhibitors (eg, nonsteroid antiinflammatory drugs [NSAIDs]) are used to close the ductus arteriosus. […] Closure of the patent ductus arteriosus (PDA) is stimulated by administration of prostaglandin synthesis inhibitors, such as indomethacin or aspirin, which is effective in premature infants. […] Indomethacin has proven efficacious, resulting in twice the spontaneous closure rate. […] Surgical ligation or surgical ligation and division remain the standard treatment of large patent ductus arteriosus (PDA) that require treatment in infancy.

• #2 Interventions for patent ductus arteriosus (PDA) in preterm infants: an overview of Cochrane Systematic Reviews – PubMed

  https://pubmed.ncbi.nlm.nih.gov/37039501/

  For prevention of PDA, prophylactic indomethacin reduces severe intraventricular haemorrhage (IVH; relative risk (RR) 0.66, 95% confidence interval (CI) 0.53 to 0.82; 14 RCTs, 2588 infants), and the need for invasive PDA closure (RR 0.51, 95% CI 0.37 to 0.71; 8 RCTs, 1791 infants), but it does not appear to affect the composite outcome of death or moderate/severe neurodevelopmental disability (RR 1.02, 95% CI 0.90 to 1.15; 3 RCTs, 1491 infants). […] Prophylactic ibuprofen probably marginally reduces severe IVH (RR 0.67, 95% CI 0.45 to 1.00; 7 RCTs, 925 infants; moderate-certainty evidence), and the need for invasive PDA closure (RR 0.46, 95% CI 0.22 to 0.96; 7 RCTs, 925 infants; moderate-certainty evidence). […] For treatment of asymptomatic PDA, indomethacin appears to reduce the development of symptomatic PDA post-treatment (RR 0.36, 95% CI 0.19 to 0.68; 3 RCTs, 97 infants; quality of source review: critically low).

• #2 Interventions for patent ductus arteriosus (PDA) in preterm infants: an overview of Cochrane Systematic Reviews – PubMed

  https://pubmed.ncbi.nlm.nih.gov/37039501/

  For treatment of symptomatic PDA, all available prostaglandin inhibitor drugs appear to be more effective in closing a PDA than placebo or no treatment (indomethacin: RR 0.30, 95% CI 0.23 to 0.38; 10 RCTs, 654 infants; high-certainty evidence; ibuprofen: RR 0.62, 95% CI 0.44 to 0.86; 2 RCTs, 206 infants; moderate-certainty evidence; early administration of acetaminophen: RR 0.35, 95% CI 0.23 to 0.53; 2 RCTs, 127 infants; low-certainty evidence). […] Oral ibuprofen appears to be more effective in PDA closure than intravenous (IV) ibuprofen (RR 0.38, 95% CI 0.26 to 0.56; 5 RCTs, 406 infants; moderate-certainty evidence). […] High-dose ibuprofen appears to be more effective in PDA closure than standard-dose ibuprofen (RR 0.37, 95% CI 0.22 to 0.61; 3 RCTs, 190 infants; moderate-certainty evidence).

• #2 Treatments to manage patent ductus arteriosus in premature babies | Cochrane

  https://www.cochrane.org/CD013588/NEONATAL_treatments-manage-patent-ductus-arteriosus-premature-babies

  For treatment of symptomatic PDA, all available prostaglandin inhibitor drugs appear to be more effective in closing a PDA than placebo or no treatment (indomethacin: RR 0.30, 95% CI 0.23 to 0.38; 10 RCTs, 654 infants; high-certainty evidence; ibuprofen: RR 0.62, 95% CI 0.44 to 0.86; 2 RCTs, 206 infants; moderate-certainty evidence; early administration of acetaminophen: RR 0.35, 95% CI 0.23 to 0.53; 2 RCTs, 127 infants; low-certainty evidence). Oral ibuprofen appears to be more effective in PDA closure than intravenous (IV) ibuprofen (RR 0.38, 95% CI 0.26 to 0.56; 5 RCTs, 406 infants; moderate-certainty evidence). High-dose ibuprofen appears to be more effective in PDA closure than standard-dose ibuprofen (RR 0.37, 95% CI 0.22 to 0.61; 3 RCTs, 190 infants; moderate-certainty evidence).

• #2

  https://link.springer.com/article/10.1007/s40272-016-0165-5

  Opinions are divided regarding the management of a persistently patent ductus arteriosus (PDA). Some of the adverse effects associated with a large hemodynamically significant duct, including prolonged ventilation, pulmonary hemorrhage, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), and mortality, indicate that active management of infants with large ductal shunts may sometimes be necessary. Indomethacin and ibuprofen are the two US FDA-approved cyclooxygenase (COX) inhibitors used for the closure of a ductus in preterm babies. Both these drugs are effective in 70-80 % of extremely low birthweight infants. Treatment with COX inhibitors may be associated with renal impairment, gastrointestinal hemorrhage, NEC, and spontaneous intestinal perforation when given concurrently with steroids, as well as changes in cerebrovascular auto-regulation. Ibuprofen appears to be a better choice for PDA closure, with a better side effect profile and efficacy that equals that of indomethacin. However, long-term outcome studies of ibuprofen are lacking, and prophylactic ibuprofen is ineffective in decreasing severe IVH. The choice of one drug over the other also depends on local availability of both drugs and the intravenous or enteral preparation. The oral preparation of ibuprofen appears as effective as the intravenous preparation. The use of paracetamol to close a hemodynamically significant PDA has increased in recent years. Paracetamol also decreases prostacyclin synthesis; however, unlike COX inhibitors, it does not have a peripheral vaso-constrictive effect and can be given to infants with contraindications to non-steroidal anti-inflammatory drugs. It appears to have similar efficacy based on limited data available from randomized trials. Until more data are available on efficacy, safety, and long-term outcomes, it cannot be recommended as the first choice.

• #2

  https://link.springer.com/article/10.1007/s40272-016-0165-5

  Hammerman C, Bin-Nun A, Markovitch E, Schimmel MS, Kaplan M, Fink D. Ductal closure with paracetamol: a surprising new approach to patent ductus arteriosus treatment. Pediatrics. 2011;128(6):e161821. […] Oncel MY, Yurttutan S, Degirmencioglu H, Uras N, Altug N, Erdeve O, Dilmen U. Intravenous paracetamol treatment in the management of patent ductus arteriosus in extremely low birth weight infants. Neonatology. 2013;103(3):1669. […] Ohlsson A, Shah SS. Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low-birth-weight infants. Cochrane Database Syst Rev. 2015;3:CD010061.

• #2 Patent ductus arteriosus (PDA) | Great Ormond Street Hospital

  https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/patent-ductus-arteriosus-pda/

  A patent ductus arteriosus increases the blood flow to the lungs. This can make it harder for the baby to breathe and come off the ventilator. […] Many babies with a PDA will have been kept on reduced fluid intake and given diuretic medicines to try to treat fluid overload caused by heart failure. […] To try to close the connection, the baby may have been given medication (often a non-steroidal antiinflammatory drug such as ibuprofen). Sometimes medication is unsuccessful or not appropriate and a surgical closure might be needed. […] The procedure involves a full team of doctors, nurses and technicians. Your baby will be asleep and so will not feel any discomfort. […] A device is then threaded through the catheter and placed into the PDA. […] The device is made of a fine wire mesh, which plugs the flow of blood flow through the PDA. […] Echocardiograms and sometimes X-rays will be done the same day and/or the next day to confirm good position of the device and closure of the PDA.

• #2 Patent Ductus Arteriosus (PDA) – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/congenital-cardiovascular-anomalies/patent-ductus-arteriosus-pda

  In full-term infants, COX inhibitors are usually ineffective. […] Transcatheter closure has become the treatment of choice for PDA in children 1 year, and some authors consider transcatheter closure to be the preferred route in term neonates and young infants as well. […] For a patent ductus arteriosus with a shunt large enough to cause symptoms of heart failure or pulmonary hypertension, closure should be done after medical stabilization. […] For preterm infants with hemodynamically significant PDA, give a cyclo-oxygenase (COX) inhibitor (eg, ibuprofen lysine or indomethacin). Surgical or transcatheter closure may benefit patients with a hemodynamically significant PDA in whom medical therapy has failed. […] For full-term infants and older children, COX inhibitors are usually ineffective, but a catheter-delivered occlusion device or surgery typically provides long-term correction of this anomaly.

• #2 Patent Ductus Arteriosus (PDA): Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/17325-patent-ductus-arteriosus-pda

  Healthcare providers may treat PDA with surgical procedures, including: Cardiac catheterization: During cardiac catheterization, experts insert a thin, flexible tube (catheter) into the groin and thread it up through a blood vessel to the heart. They insert a plug or coil into the heart through the catheter to close the PDA and stop patent ductus arteriosus blood flow. Providers typically dont perform cardiac catheterization on premature babies, though older babies and children can have this procedure. Patent ductus arteriosus surgery: Surgeons make an incision in the side of the chest. They close the PDA with stitches (sutures) or a metal clip. […] After catheterization or surgery, blood flow returns to normal immediately if there are no other heart defects. […] Closing the PDA gets blood flow back to normal. After closure via a cardiac catheterization, your child will take antibiotics for six months to prevent heart infection (endocarditis). Your healthcare provider will discuss the necessary follow-up care with you.

• #2 Patent Ductus Arteriosus (PDA) – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/topic/default?id=patent-ductus-arteriosus-pda-90-P01811

  Treatment will depend on your childs symptoms, age, and general health. It will also depend on how severe the condition is. […] A PDA that causes symptoms will need to be treated with medicine, cardiac catheterization, or surgery. […] Your baby may need medicines help the heart work better. […] In premature infants, the medicine indomethacin may help close the PDA. It is given by IV (intravenously). Indomethacin stimulates the muscles inside the PDA to tighten. This closes the connection. […] Some babies may need medicine to help the heart and lungs work better. […] For this test, your baby will be given medicine to relax (sedation). The healthcare provider will put a thin, flexible tube (catheter) into a blood vessel in the groin. […] Surgery can close PDAs. Surgical closure is often advised for babies younger than 6 months who have large defects and symptoms such as poor weight gain and fast breathing. […] If not treated, PDA may lead to long-term lung damage. […] Most children with a fixed PDA will live normal, healthy lives.

• #2 Management of the patent ductus arteriosus among infants born at 23 to 32 weeks’ gestation between 2011 to 2022: a report from in the Children’s Hospitals Neonatal Consortium | Journal of Perinatology

  https://www.nature.com/articles/s41372-025-02257-6

  This study reports on patent ductus arteriosus (PDA) therapy trends across the Childrens Hospital Neonatal Consortium. […] Use of pharmacotherapy increased 44% (relative) over time, mostly with increased acetaminophen use. […] While the rate of definitive closure did not change, use of transcatheter PDA closure increased from 0 to 20.3% and surgical ligation decreased from 25.1% to 3.6%. […] There has been an increase in the use of multiple pharmacotherapies for PDA, especially among infants born 27 weeks gestation. […] Transcatheter PDA closure has overtaken surgical ligation as the primary method of definitive PDA closure. […] The management of the PDA in extremely premature infants at risk for cardiovascular compromise remains a long-standing clinical conundrum in the field of neonatology, but understanding contemporary trends of PDA care is a necessary step to filling in knowledge gaps.

• #2 Management of the patent ductus arteriosus among infants born at 23 to 32 weeks’ gestation between 2011 to 2022: a report from in the Children’s Hospitals Neonatal Consortium | Journal of Perinatology

  https://www.nature.com/articles/s41372-025-02257-6

  In this multicenter, 12-year retrospective observational study of infants managed in CHNC NICUs, we identified a shift in the choice of definitive PDA closure from surgical ligation to TCPC. […] In addition, there were changes in pharmacotherapy including an overall increase in pharmacotherapy use in the most premature infants, increases in acetaminophen and multi-drug therapy, and a decrease in indomethacin use. […] The rapid adoption of TCPC over the study period in CHNC institutions has been balanced by the steady rates of overall definitive closure. […] TCPC use has grown, beginning in 2016, to 85% of definitive closures during epoch 4 while surgical ligation use has decreased from 100% of definitive closures in epoch 1 to 15% in epoch 4. […] The trends for definitive closure over the past decade have varied based on the years examined and the gestational ages of included infants.

• #2 Patent Ductus Arteriosus | UCSF Department of Surgery

  https://pedctsurgery.ucsf.edu/condition/patent-ductus-arteriosus

  Catheters are thin, flexible tubes used in a procedure called cardiac catheterization. Catheter-based procedures often are used to close PDAs in infants or children who are large enough to have the procedure. […] Your child’s doctor may refer to the procedure as „transcatheter device closure.” The procedure sometimes is done on small PDAs to prevent the risk of infective endocarditis (IE), an infection of the lining of the heart, valves, or arteries. […] Surgery for PDA may be done if: A premature or full-term infant develops health problems from the PDA and is too small to have a catheter-based procedure, A PDA isn’t successfully closed by a catheter-based procedure, Surgery is planned for treatment of related congenital heart defects. […] After surgery, your child will spend a few days in the hospital. He or she will be given medicines to reduce pain and anxiety. Most children go home 2 days after surgery. […] Long-term complications from surgery are rare. However, they can include narrowing of the aorta, incomplete closure of the PDA, and reopening of the PDA.

• #2 Patent Ductus Arteriosus (PDA) | American Heart Association

  https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart-defects/patent-ductus-arteriosus-pda

  Persistencia del ductus arterioso […] If the PDA (ductus) is small, it doesn’t make the heart and lungs work harder. Surgery and other treatments may not be needed. Small PDAs often close on their own within the first few months of life. […] Most children can have the PDA closed by inserting catheters (long thin tubes) into the blood vessels in the leg to reach the heart and the PDA, and a device can be inserted through the catheters into the PDA like a plug. […] If surgery is needed, an incision is made in the left side of the chest, between the ribs. The ductus is closed by tying it with suture (thread-like material) or by permanently placing a small metal clip around the ductus to squeeze it closed. […] In premature newborn babies, medicine can often help the ductus close. After the first few weeks of life, medicine won’t work as well to close the ductus and surgery may be required.

• #2 Patent Ductus Arteriosus: Symptoms and Treatment | Doctor

  https://patient.info/doctor/patent-ductus-arteriosus

  In asymptomatic well infants current practice is to wait until 1 year of age, with regular echocardiographic evaluation to check for spontaneous closure of the PDA. If the duct is still patent at 1 year of age it can be closed usually by occlusion at cardiac catheterisation (endovascular occlusion). […] Serious complications of transcatheter closure of PDA are rare and include device embolisation, femoral artery or vein thrombosis related to vascular access and infection. […] Management of PDA in the preterm infant remains controversial, with diverse approaches ranging from very conservative management to aggressive early closure of the duct pharmacologically or surgically. […] Indometacin is used as standard therapy to close a PDA but is associated with reduced blood flow to several organs. Ibuprofen is as effective as indometacin in closing a PDA. […] Surgical ligation of the duct is associated with significant morbidity (hypotension, pneumothorax, vocal cord paralysis) and mortality. […] Echocardiography-guided catheter closure of the ductus in small preterm babies in the neonatal intensive care unit has been reported from Oxford.

• #2

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=aci3389

  Patent ductus arteriosus (PDA) surgery is done to close a blood vessel called the ductus arteriosus. Normally, this blood vessel closes after birth. But in PDA, it stays open. This causes some of the blood that should go from the heart to the body to go to the lungs instead. […] PDA surgery allows blood to flow normally through the blood vessels and the heart. It’s done when the opening is large enough that it causes symptoms such as trouble breathing. It may also be done if another treatment for PDA isn’t possible or didn’t work. […] Some babies have the surgery as soon as the problem is found. Other times, surgery is delayed until a child has symptoms or until a child is healthy enough to have surgery. […] PDA surgery is done on the blood vessel, not the heart. […] After the surgery, your child may be taken to a recovery room or to the pediatric intensive care unit (PICU).

• #2 Patent ductus arteriosus (PDA) in term infants, children, and adults: Management – UpToDate

  https://www.uptodate.com/contents/patent-ductus-arteriosus-pda-in-term-infants-children-and-adults-management

  Patent ductus arteriosus (PDA) in term infants, children, and adults: Management […] The management of PDA in term infants, older children, and adults will be reviewed here. […] Management decisions for patients with PDA are based upon the degree of left-to-right shunting, the age and size of the patient, and the values and preferences of the patient and parents/caregivers. The following sections outline our general approach. Additional details on closure interventions are provided below. […] In patients with a PDA, the primary management decision is whether to actively close the PDA or to conservatively observe and monitor the patient’s cardiac status on a regular basis.

• #2 Diagnosis and Management of Patent Ductus Arteriosus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6269146/

  Preterm infants are at increased risk for patent ductus arteriosus (PDA). Prolonged exposure to PDA may be deleterious and has been associated with neonatal morbidity and mortality. […] This review discusses the evolving indications for treatment of a PDA and the various treatment options available. […] Some clinicians choose a prophylactic approach to indomethacin treatment, with a goal of preventing IVH, PDA, and the adverse consequences that have been associated with PDA in extremely low-birthweight infants. […] The indications for treatment of a symptomatic PDA include respiratory compromise (eg, requiring persistent mechanical support), heart failure, or large left-to-right ductus shunt with evidence of hemodynamic compromise, such as reversal of flow in the descending aorta during diastole, oliguria or rising serum creatinine concentration, hypotension, or wide pulse pressure.

• #2 Patent Ductus Arteriosus (PDA) | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/p/patent-ductus-arteriosus-pda.html

  Surgery can close PDAs. Surgical closure is often advised for babies younger than 6 months who have large defects and symptoms, such as poor weight gain and fast breathing. For babies who don’t have symptoms, any surgery may be delayed until after age 6 to 12 months. Your child’s cardiologist will advise when the surgery should be done. It is done under general anesthesia so your child will be asleep. Surgery closes the PDA with stitches or clips. This stops the extra blood from getting into the lungs. […] Most children with a fixed PDA will live normal, healthy lives.

• #2 Patent ductus arteriosus | PDA heart defect | Children’s Wisconsin

  https://childrenswi.org/medical-care/herma-heart/conditions/patent-ductus-arteriosus

  The surgical repair, also called PDA ligation, is performed under general anesthesia. […] The cardiac catheterization procedure may also be an option for treatment. […] Some children who undergo PDA ligation may need to spend some time in the intensive care unit after surgery. […] You will also learn how to care for your child at home before your child is discharged. […] Most children will only need to stay in the hospital for a few days after the operation. […] After patent ductus arteriosus surgery, older children usually have a fair tolerance for activity. […] Your child’s cardiologist may recommend that antibiotics be given to prevent bacterial endocarditis for a specific time period after discharge from the hospital if the coil or occluder device was used.

• #2 Personalized Evidence-Based Management of Patent Ductus Arteriosus in Preterm Infants

  https://www.mdpi.com/2308-3425/11/1/7

  Prophylactic treatment involves using indomethacin within the first 6–24 h after birth to prevent IVH in preterm infants. […] If treatment for hsPDA is initiated beyond 7 days after birth, high-dose oral ibuprofen is preferred due to its efficacy, especially in infants tolerating enteral feeds. […] Hence it can be considered after a single course of pharmacological therapy, or at least these infants should be discussed with pediatric cardiologists as organizing transcatheter closure of PDA takes time. […] In conclusion, the management of PDA in preterm infants, especially in extremely preterm infants under 26 weeks of gestation, is a multi-faceted challenge. Both the medical treatment of PDA with pharmacological agents and invasive procedures (percutaneous transcatheter device closure and surgical ligation) have their risks and benefits.

• #3 Patent Ductus Arteriosus (PDA) | American Heart Association

  https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart-defects/patent-ductus-arteriosus-pda

  Persistencia del ductus arterioso […] If the PDA (ductus) is small, it doesn’t make the heart and lungs work harder. Surgery and other treatments may not be needed. Small PDAs often close on their own within the first few months of life. […] Most children can have the PDA closed by inserting catheters (long thin tubes) into the blood vessels in the leg to reach the heart and the PDA, and a device can be inserted through the catheters into the PDA like a plug. […] If surgery is needed, an incision is made in the left side of the chest, between the ribs. The ductus is closed by tying it with suture (thread-like material) or by permanently placing a small metal clip around the ductus to squeeze it closed. […] In premature newborn babies, medicine can often help the ductus close. After the first few weeks of life, medicine won’t work as well to close the ductus and surgery may be required.

• #3 Interventions for patent ductus arteriosus (PDA) in preterm infants: an overview of Cochrane Systematic Reviews – PubMed

  https://pubmed.ncbi.nlm.nih.gov/37039501/

  For treatment of symptomatic PDA, all available prostaglandin inhibitor drugs appear to be more effective in closing a PDA than placebo or no treatment (indomethacin: RR 0.30, 95% CI 0.23 to 0.38; 10 RCTs, 654 infants; high-certainty evidence; ibuprofen: RR 0.62, 95% CI 0.44 to 0.86; 2 RCTs, 206 infants; moderate-certainty evidence; early administration of acetaminophen: RR 0.35, 95% CI 0.23 to 0.53; 2 RCTs, 127 infants; low-certainty evidence). […] Oral ibuprofen appears to be more effective in PDA closure than intravenous (IV) ibuprofen (RR 0.38, 95% CI 0.26 to 0.56; 5 RCTs, 406 infants; moderate-certainty evidence). […] High-dose ibuprofen appears to be more effective in PDA closure than standard-dose ibuprofen (RR 0.37, 95% CI 0.22 to 0.61; 3 RCTs, 190 infants; moderate-certainty evidence).

• #3 What Is the Best Treatment for Symptomatic Patent Ductus Arteriosus?logo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na46425/2018/05/08/what-best-treatment-symptomatic-patent-ductus-arteriosus

  High-dose oral ibuprofen is superior to other medical options for closure of a clinically significant PDA. […] For infants receiving treatment for a hemodynamically significant PDA, high-dose oral ibuprofen appears to be the most effective medical option for closing the ductus and avoiding surgical ligation and other morbidity.

• #3 Patent Ductus Arteriosus – Children’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/children-s-health-issues/birth-defects-of-the-heart/patent-ductus-arteriosus

  In patent ductus arteriosus (PDA), the blood vessel connecting the pulmonary artery and the aorta (ductus arteriosus) fails to close as it usually does shortly after birth. […] Treatment with ibuprofen or indomethacin often helps to close the PDA, particularly in premature infants. If drugs are not successful, surgery may be done. […] In full-term newborns, treatment with medications is less likely to be successful, especially since these infants are usually a bit older when the diagnosis of PDA is made. Unless they have symptoms, surgical treatment is often delayed beyond one or two years of age because the ductus arteriosus may close on its own. […] Indomethacin or ibuprofen can be given to close a patent ductus arteriosus. These medications are most effective if given within the first 10 days after birth and are more effective in premature newborns than in full-term ones. Several doses may be given. If the PDA does not close after several doses, catheter intervention or surgery may be done if there are signs that the PDA is harming the lungs and heart.

• #3 Patent Ductus Arteriosus (PDA) – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/congenital-cardiovascular-anomalies/patent-ductus-arteriosus-pda

  In full-term infants, COX inhibitors are usually ineffective. […] Transcatheter closure has become the treatment of choice for PDA in children 1 year, and some authors consider transcatheter closure to be the preferred route in term neonates and young infants as well. […] For a patent ductus arteriosus with a shunt large enough to cause symptoms of heart failure or pulmonary hypertension, closure should be done after medical stabilization. […] For preterm infants with hemodynamically significant PDA, give a cyclo-oxygenase (COX) inhibitor (eg, ibuprofen lysine or indomethacin). Surgical or transcatheter closure may benefit patients with a hemodynamically significant PDA in whom medical therapy has failed. […] For full-term infants and older children, COX inhibitors are usually ineffective, but a catheter-delivered occlusion device or surgery typically provides long-term correction of this anomaly.

• #3 Patent Ductus Arteriosus (PDA) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/patent-ductus-arteriosus

  Treatments include surgery and catheterization. […] The traditional treatment for a PDA that doesn’t close naturally is heart surgery. […] Catheterization techniques to close a PDA were developed in 1990s and are now the standard of care in children. […] In many cases a PDA will resolve on its own in the first few months or at least within the first year of life. Medication may be prescribed to help the ductus close. If medication isn’t effective or a baby’s health is endangered, catheterization or a surgical procedure may be required to close the PDA. […] Surgery: Using a traditional surgical approach, the surgeon makes an incision between the ribs on the left side of the baby’s chest, using either sutures or a clip to close the ductus. […] Catheterization: This minimally invasive approach involves only a small needle puncture in the leg.

• #3 Patent Ductus Arteriosus | Duke Health

  https://www.dukehealth.org/pediatric-treatments/patent-ductus-arteriosus

  Duke pediatric cardiologists and surgeons are experts in diagnosing and treating patent ductus arteriosus safely and effectively. […] While not an option for all children, acetaminophen, ibuprofen, or indomethacin may help close a PDA in premature infants. […] Most PDAs can be closed using a minimally invasive catheterization procedure. […] A pediatric heart surgeon makes a small incision between the ribs and under the left shoulder blade, navigates to the ductus, and places a permanent metal clip or suture to squeeze the vessel closed. […] Duke offers a minimally invasive catheterization procedure and a plug-like device that was FDA-approved in 2019 for PDA closure in tiny infants (those who weigh more than 700 grams, which is about 24 ounces). […] Duke Childrens Hospital is verified as a Level I Children’s Surgery Center by the American College of Surgeons.

• #3 Patent Ductus Arteriosus (PDA) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/patent-ductus-arteriosus

  A team of doctors usually determines the best approach to fixing the PDA. […] Some cardiologists would like to make catheterization the standard of care for as many young heart patients with PDA as possible. […] In a very small infant, surgery can often make the baby sicker as an initial response to the operation. […] The babies we’ve treated with catheterization have all sort of not noticed the procedure, which is wonderful. […] Some patients with PDAs have other heart defects as well; catheterization can be better for those who will require multiple surgeries in the first few years of life, Dr. Asnes says.

• #3 Patent Ductus Arteriosus: Symptoms and Treatment | Doctor

  https://patient.info/doctor/patent-ductus-arteriosus

  Patent ductus arteriosus (PDA) occurs in 5-10% of all congenital heart defects, excluding premature infants. […] This article primarily focuses on the PDA as a congenital heart defect, with a separate section dealing with PDA in preterm babies at the end. […] Indometacin is ineffective in term infants with PDA and should not be used. Medical management is limited to use of decongestive measures such as diuretics in those with features of heart failure. […] PDA closure is indicated for any symptomatic infant, child or adult (with exclusion of those with fixed high pulmonary vascular resistance). Closure is also indicated in asymptomatic patients with left heart volume load. This can be done either by surgery or interventional techniques at any age. […] Surgical closure is reserved for patients in whom a non-surgical closure technique is not considered applicable. In infants with heart failure or pulmonary hypertension, surgery is performed on an urgent basis. The standard surgical procedure is ligation and division of the ductus through left posterolateral thoracotomy without cardiopulmonary bypass.

• #3 Patent Ductus Arteriosus | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/patent-ductus-arteriosus

  The goal is to close the patent ductus arteriosus before the lungs become damaged from too much blood flow. In premature infants, medications may help close the patent ductus. These medications include indomethacin, ibuprofen, Tylenol, each working by stimulating the muscles inside the patent ductus arteriosus to tighten, closing the connection. […] In many cases your child’s patent ductus arteriosus may be repaired by a cardiac catheterization procedure. […] Recently, a new transcatheter device was approved by the FDA to close a patent ductus arteriosus in extremely low birth weight newborns, making it possible for many more patients to benefit from this minimally invasive procedure. […] Surgical repair (ligation) is recommended for children for whom a catheter-based procedure is not an option.

• #3 Patent Ductus Arteriosus | UCSF Department of Surgery

  https://pedctsurgery.ucsf.edu/condition/patent-ductus-arteriosus

  Catheters are thin, flexible tubes used in a procedure called cardiac catheterization. Catheter-based procedures often are used to close PDAs in infants or children who are large enough to have the procedure. […] Your child’s doctor may refer to the procedure as „transcatheter device closure.” The procedure sometimes is done on small PDAs to prevent the risk of infective endocarditis (IE), an infection of the lining of the heart, valves, or arteries. […] Surgery for PDA may be done if: A premature or full-term infant develops health problems from the PDA and is too small to have a catheter-based procedure, A PDA isn’t successfully closed by a catheter-based procedure, Surgery is planned for treatment of related congenital heart defects. […] After surgery, your child will spend a few days in the hospital. He or she will be given medicines to reduce pain and anxiety. Most children go home 2 days after surgery. […] Long-term complications from surgery are rare. However, they can include narrowing of the aorta, incomplete closure of the PDA, and reopening of the PDA.

• #3 Get Patent Ductus Arteriosus Treatment | Cleveland Clinic Children’s

  https://my.clevelandclinic.org/pediatrics/services/patent-ductus-arteriosus-treatment

  Babies are born with a blood vessel (ductus arteriosus) thats supposed to close soon after birth. Sometimes it doesnt, so blood doesnt flow through your babys heart like it should. This is called patent ductus arteriosus (PDA) and it can affect how well they breathe, eat and grow. […] Once we know for sure that your baby has patent ductus arteriosus, well work with you to design a personalized treatment plan. The plan will be based on their test results and your babys age, weight and health. There are several different things we can do. […] Mild or small PDA often gets better on its own within a few months and doesnt need treatment. In these cases, your babys healthcare providers will keep an eye on their health and symptoms. If your baby needs further care, well guide you through the next steps.

• #3 Management of the patent ductus arteriosus in preterm infants | Canadian Paediatric Society

  https://cps.ca/documents/position/patent-ductus-arteriosus

  Selective prophylaxis with intravenous (IV) indomethacin may be considered in ELBW infants at high risk for severe IVH (conditional recommendation). There is insufficient evidence to recommend prophylactic ibuprofen or acetaminophen in extremely preterm or ELBW infants. […] Ibuprofen should be considered the pharmacotherapy of choice for a symptomatic PDA (strong recommendation). High-dose ibuprofen may be considered as the preferred dosage, especially for preterm infants beyond the first 3 to 5 days of age (conditional recommendation). Exercise caution when treating extremely preterm infants (26 weeks GA) with high-dose ibuprofen due to limited safety and efficacy data. […] A second course of COX-I therapy should be considered over invasive management for a persistent, symptomatic PDA when there are no contraindications (strong recommendation). The benefit of a third course of pharmacotherapy with enteral acetaminophen is unclear but may be considered after discussion with the infants parents or guardians, especially while awaiting invasive PDA closure (conditional recommendation).

• #3 Get Patent Ductus Arteriosus Treatment | Cleveland Clinic Children’s

  https://my.clevelandclinic.org/pediatrics/services/patent-ductus-arteriosus-treatment

  If your babys symptoms interfere with their growth or well-being, they may need medications. Our providers may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) for premature babies, which can help the ductus arteriosus to close on its own. […] In more severe cases of PDA, our pediatric cardiologists (heart specialists) will do a cardiac catheterization. This can close the ductus arteriosus. […] Sometimes less invasive treatments arent an option. Then, our pediatric heart surgeons will do surgery to close the ductus arteriosus. During PDA surgery, well make an incision in your babys chest to close the open blood vessel with sutures or a special clip. After surgery, your babys PDA symptoms should quickly go away. […] After a cardiac catheterization or PDA surgery, your baby or child will need to take antibiotics if theyre going to the dentist within 6 months of the procedure. This will prevent their heart from getting infected.

• #3

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=aci3389

  After surgery, your child will likely feel better. […] Follow-up care is a key part of your child’s treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line if your child is having problems. It’s also a good idea to know your child’s test results and keep a list of the medicines your child takes.

• #3 Management of the patent ductus arteriosus among infants born at 23 to 32 weeks’ gestation between 2011 to 2022: a report from in the Children’s Hospitals Neonatal Consortium | Journal of Perinatology

  https://www.nature.com/articles/s41372-025-02257-6

  In our study, overall rates of definitive closure amongst babies with a PDA was the same over the 12-year time from 2011 to 2022, mirroring the results from Leahey et al. and the Vermont Oxford Network database from 2018 to 2022. […] The increased rates of PDA pharmacotherapy in our population of infants born 23 to 26 weeks gestation suggests infants transferred to Level IV NICUs are frequently selected to receive treatment for the PDA and may be treated with multiple PDA therapies. […] The increase in acetaminophen use, both at the referring center and at the CHNC center, highlights the desire to close the PDA without the side effects of indomethacin or ibuprofen. […] Our finding that both acetaminophen and multiple PDA therapies have increased over time may support the decreased efficacy of acetaminophen if physicians are using acetaminophen as first-line therapy and choosing another medication if the ductus remains patient after acetaminophen therapy.

• #3 Interventions for patent ductus arteriosus (PDA) in preterm infants: an overview of Cochrane Systematic Reviews – PubMed

  https://pubmed.ncbi.nlm.nih.gov/37039501/

  All available prostaglandin inhibitor drugs appear to be effective in symptomatic PDA closure compared to no treatment (high-certainty evidence for indomethacin; moderate-certainty evidence for ibuprofen; low-certainty evidence for early administration of acetaminophen). […] There are currently two ongoing reviews, one on fluid restriction for symptomatic PDA, and the other on invasive management of PDA in preterm infants.

• #3 Personalized Evidence-Based Management of Patent Ductus Arteriosus in Preterm Infants

  https://www.mdpi.com/2308-3425/11/1/7

  Prophylactic treatment involves using indomethacin within the first 6–24 h after birth to prevent IVH in preterm infants. […] If treatment for hsPDA is initiated beyond 7 days after birth, high-dose oral ibuprofen is preferred due to its efficacy, especially in infants tolerating enteral feeds. […] Hence it can be considered after a single course of pharmacological therapy, or at least these infants should be discussed with pediatric cardiologists as organizing transcatheter closure of PDA takes time. […] In conclusion, the management of PDA in preterm infants, especially in extremely preterm infants under 26 weeks of gestation, is a multi-faceted challenge. Both the medical treatment of PDA with pharmacological agents and invasive procedures (percutaneous transcatheter device closure and surgical ligation) have their risks and benefits.

• #3 Patent Ductus Arteriosus | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/patent-ductus-arteriosus

  Most children with a patent ductus will live healthy lives after recovering from the repair. Their activity levels, appetite, and growth should return to normal. […] Our approach to the treatment of patent ductus at the Boston Children’s Hospital Benderson Family Heart Center is a carefully coordinated approach by multiple specialties. We offer treatments, including medical therapy, minimally invasive catheter-based interventions, and minimally invasive surgical solutions.

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