Volume 20 No 12 (2022)
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Treatment Options of Patent Ductus Arteriosus
Ahmed Alaa Hamed , Lotfy mohammed Elsayed , Rania Diaa Eldin Aboushokka , Hesham mohamed abdallah , Raafat Hassan Salama, Sherief m. El Gebaly
Abstract
Small PDA that does not cause symptoms should be followed medically for 6 months without surgical ligation because of the possibility of spontaneous closure. If left untreated, the mortality rate for PDA is 20% by age 20 years.Although there is no clear evidence of clinical efficacy, various approaches including fluid restriction, increasing PEEP, permissive hypercapnia, maintaining a high haematocrit and higher target SpO2 (89-94%) have all been used as part of a ‘conservative’ approach to managing a hsPDA.There is some evidence that furosemide stimulates renal synthesis of prostaglandin E2 (a dilator of the ductus arteriosus) and delays ductal closure. The risk of PDA is greater with furosemide compared with chlorothiazide. Furosemide is associated with nephroand ototoxicity.Ibuprofen is effective in achieving ductal closure in around 70-80% of cases . There is some evidence that oral therapy and higher dosage regimens are associated with higher closure rates.Paracetamol has comparable efficacy to ibuprofen in ductal closure but there is limited information on long-term safety.There is some evidence to support the use of paracetamol in late treatment of PDA after failure of previous NSAID therapy, although the efficacy in achieving ductal closure was only 15%.
Keywords
Patent ductus arteriosus
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