{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T23:46:41Z","timestamp":1793663201122,"version":"4.5.1"},"reference-count":108,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11,1]]},"abstract":"<jats:p>Postnatal ductal closure is stimulated by rising oxygen tension and withdrawal of vasodilatory mediators (prostaglandins, nitric oxide, adenosine) and by vasoconstrictors (endothelin-1, catecholamines, contractile prostanoids), ion channels, calcium flux, platelets, morphologic maturity, and a favorable genetic predisposition. A persistently patent ductus arteriosus (PDA) in preterm infants can have clinical consequences. Decreasing pulmonary vascular resistance, especially in extremely low gestational age newborns, increases left-to-right shunting through the ductus and increases pulmonary blood flow further, leading to interstitial pulmonary edema and volume load to the left heart. Potential consequences of left-to-right shunting via a hemodynamically significant patent ductus arteriosus (hsPDA) include increased risk for prolonged ventilation, bronchopulmonary dysplasia, necrotizing enterocolitis or focal intestinal perforation, intraventricular hemorrhage, and death. In the last decade, there has been a trend toward less aggressive treatment of PDA in preterm infants. However, there is a subgroup of infants who will likely benefit from intervention, be it pharmacologic, interventional, or surgical: (1) prophylactic intravenous indomethacin in highly selected extremely low gestational age newborns with PDA (&amp;lt;26 + 0\/7 weeks\u2019 gestation, &amp;lt;750 g birth weight), (2) early targeted therapy of PDA in selected preterm infants at particular high risk for PDA-associated complications, and (3) PDA ligation, catheter intervention, or oral paracetamol may be considered as rescue options for hsPDA closure. The impact of catheter-based closure of hsPDA on clinical outcomes should be determined in future prospective studies. Finally, we provide a novel treatment algorithm for PDA in preterm infants that integrates the several treatment modalities in a staged approach.<\/jats:p>","DOI":"10.1542\/peds.2020-1209","type":"journal-article","created":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T08:35:24Z","timestamp":1603355724000},"source":"Crossref","is-referenced-by-count":299,"title":["Patent Ductus Arteriosus of the Preterm Infant"],"prefix":"10.1542","volume":"146","author":[{"given":"Shannon E.G.","family":"Hamrick","sequence":"first","affiliation":[{"name":"Divisions of Neonatology and"},{"name":"Cardiology, Department of Pediatrics, Emory University and Children\u2019s Healthcare of Atlanta, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannes","family":"Sallmon","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Charit\u00e9 University Medical Center, Berlin, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison T.","family":"Rose","sequence":"additional","affiliation":[{"name":"Divisions of Neonatology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Porras","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine L.","family":"Shelton","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Vanderbilt University Medical Center, Nashville, Tennessee; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff","family":"Reese","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Vanderbilt University Medical Center, Nashville, Tennessee; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Hansmann","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2020,11,1]]},"reference":[{"issue":"5","key":"2021121016214367200_B1","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1542\/peds.2009-3506","article-title":"Patent ductus arteriosus of the preterm infant","volume":"125","author":"Hamrick","year":"2010","journal-title":"Pediatrics"},{"issue":"2","key":"2021121016214367200_B2","doi-asserted-by":"crossref","first-page":"e0212256","DOI":"10.1371\/journal.pone.0212256","article-title":"Natural evolution of ductus arteriosus with noninterventional conservative management in extremely preterm infants born at 23\u201328 weeks of gestation","volume":"14","author":"Sung","year":"2019","journal-title":"PLoS One"},{"issue":"10","key":"2021121016214367200_B3","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1056\/NEJM200009073431009","article-title":"Ibuprofen and patent ductus arteriosus","volume":"343","author":"Clyman","year":"2000","journal-title":"N Engl J Med"},{"issue":"11","key":"2021121016214367200_B4","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1038\/s41372-019-0518-3","article-title":"Pharmacological closure of the patent ductus arteriosus: when treatment still makes sense","volume":"39","author":"Gillam-Krakauer","year":"2019","journal-title":"J Perinatol"},{"issue":"5","key":"2021121016214367200_B5","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1016\/j.jpeds.2015.06.032","article-title":"Natural history of patent ductus arteriosus in very low birth weight infants after discharge","volume":"167","author":"Weber","year":"2015","journal-title":"J Pediatr"},{"issue":"1","key":"2021121016214367200_B6","doi-asserted-by":"crossref","first-page":"F48","DOI":"10.1136\/adc.2007.129270","article-title":"Spontaneous closure of the patent ductus arteriosus in very low birth weight infants following discharge from the neonatal unit","volume":"94","author":"Herrman","year":"2009","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"3","key":"2021121016214367200_B7","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1159\/000500269","article-title":"Patent ductus arteriosus and the effects of its late closure in preterm infants with severe bronchopulmonary dysplasia","volume":"116","author":"Ansems","year":"2019","journal-title":"Neonatology"},{"issue":"4","key":"2021121016214367200_B8","doi-asserted-by":"crossref","first-page":"F244","DOI":"10.1136\/adc.2006.104596","article-title":"Conservative treatment for patent ductus arteriosus in the preterm","volume":"92","author":"Vanhaesebrouck","year":"2007","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"3","key":"2021121016214367200_B9","doi-asserted-by":"crossref","first-page":"F235","DOI":"10.1136\/adc.2004.057638","article-title":"Is surgical ligation of patent ductus arteriosus necessary? 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