Clinical Significance and Treatment Strategies of Patent Ductus Arteriosus in Preterm Infants: An Evidence-Based Approach to Decision-Making

초록

The pathophysiology of patent ductus arteriosus (PDA) is conventionally attributed to increased pulmonary blood flow and reduced systemic organ perfusion caused by left-to-right ductal shunting. Although PDA has been associated with major complications of prematurity and neurodevelopmental impairment, establishing direct causality remains challenging due to multiple confounders, including interactions among risk factors inherent to prematurity, variability in PDA severity and exposure duration, and the effects of interventions themselves. Accumulating evidence supports interpreting PDA in preterm infants as a biomarker of physiological vulnerability and comorbidity severity rather than as a primary causative condition. Prophylactic or early routine pharmacological closure has not demonstrated consistent benefits over conservative management with expectant closure in terms of mortality, short-term morbidity, or long-term neurodevelopmental outcomes. Prospective studies have confirmed that conservative management is a viable treatment strategy even in extremely preterm infants born before 28 weeks of gestation. Major international guidelines recommend that closure be considered only when echocardiographic evidence of hemodynamic compromise is accompanied by clinical symptoms, with pharmacological therapy as the first-line treatment. When pharmacological treatment fails or is contraindicated, the choice and timing of transcatheter ductal occlusion or surgical ligation should be determined based on the patient’s cardiorespiratory status, comorbidities, institutional availability, and anticipated risks. PDA management should be guided by the clinical judgment of experienced neonatologists with comprehensive knowledge of each patient rather than by adherence to uniform protocols. In the domestic neonatal care setting, individualized management strategies developed through multidisciplinary collaboration should be given appropriate consideration.

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