Management of Patent Ductus Arteriosus in Very Preterm Infants in the Post-surfactant Era

Current methods of diagnosis and treatment of patent ductus arteriosus in an era in which surfactant replacement therapy is being used routinely in respiratory distress syndrome are reviewed. Surfactant results in the early development of a left-to-right ductal shunt that affects the clinical presentation of the ductus in very preterm infants. The timing and indications for echocardiography in a cohort of very preterm infants at Monash Medical Centre were reported, and a comparison was made between those whose ductus was suspected and treated early within one week with those who presented later. Necrotising enterocolitis following indomethacin was seen only with early therapy, and treatment failure required surgical closure only with late therapy. The incidence of chronic lung disease was similar in the two groups. In the post- surfactant era, the optimal protocol for the management of the ductus requires further study in very preterm infants.