View source for Patent ductus arteriosus medical therapy in preterm infants

__NOTOC__
{{Patent ductus arteriosus}}
{{CMG}}; '''Associate Editor-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com], {{CZ}}; '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu]
==Overview==
[[Prostaglandin|Prostaglandin E2]] plays a key role in maintaining the patency of [[ductus arteriosus]] before [[birth]]. Thus, prostaglandin E2 inhibitors are used as a therapeutic options to close the patent ductus arteriosus.

==Medical Therapy==
In term [[infant]]s the ductus closure occur by 24 hours of birth in 50% of babies, by 48 hours in 90% of babies and by 72 hours in most of them. However, the ductal closure is delayed in [[preterm]] infants.

Ductal constriction occurs after birth due to the following reasons
* The increased oxygen tension after [[birth]] with the onset of [[breathing]].
* Decreased [[prostaglandin|prostaglandin E2]] due to removal of [[placenta]].
* Increased removal of prostaglandin E2 from [[lung]]. 
====Pharmacotherapy====
* Prostaglandin E2 has been found to play a key role in maintaining the patency of ductus arterisus (DA) in the [[fetal]] life. Thus, the use of inhibitors of prostaglandin synthesis (e.g, [[indomethacin]] and [[ibuprofen]]) have been found to be effective in the treatment of PDA. These [[drug]]s were also found to be useful in ductus closure if given antenatally. Patients with cases involving the [[transposition of the great vessels|transposition of the great vessels (TGV)]] may need the ductus arteriosus kept open with prostaglandin E1 (PGE1).
* [[Steroid]]s like [[hydrocortisone]] have been found to decrease the sensitivity of ductus to PGE2. Thus, facilitating ductal constriction.
* [[Nitric oxide]] synthesized from [[endothelial cell]]s have been shown to cause ductus constriction in animal studies.

==2008 ACC/AHA Guidelines for the Management of Adults with Congenital Heart Disease (DO NOT EDIT)<ref name="pmid19038677">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= e1-121 | pmid=19038677 | doi=10.1016/j.jacc.2008.10.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038677  }} </ref> ==
=== Recommendations for Medical Therapy (DO NOT EDIT)<ref name="pmid19038677">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= e1-121 | pmid=19038677 | doi=10.1016/j.jacc.2008.10.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038677  }} </ref> ===


{| class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Routine follow-up is recommended for patients with a small PDA without evidence of left-sided heart volume overload. Follow-up is recommended every 3 to 5 years for patients with a small PDA without evidence of left-heart volume overload. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>

|}

{| class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]

|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' [[Endocarditis prophylaxis]] is not recommended for those with a repaired PDA without residual [[shunt]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>

|}

==References==
{{reflist|2}}


[[Category:Disease]]
[[Category:Cardiology]]
[[Category:Congenital heart disease]]
[[Category:Pediatrics]]