The ductus arteriosus (DA) is clinically silent in the first day, a period when many very preterm infants have low systemic blood flow (SBF). An echocardiographically detected large diameter DA in the 1st day has been associated with low SBF which in turn is associated with increased risk of mortality and abnormal neuro development. However, limited data suggest that closing an early large DA does not increase SBF. Although in the majority of infants the DA eventually closes spontaneously, up to 50% of very preterm infants develop a symptomatic DA with signs of respiratory distress and organ dysfunction. Echocardiography is used to accurately confirm the diagnosis and determine haemodynamic significance.
The optimal strategy for managing the DA in the very preterm infant is yet to be determined. Prophylactic indomethacin significantly reduces the incidence of severe IVH without benefit in mortality and neurodevelopment. Early treatment of the infant with a clinical DA whether asymptomatic or symptomatic also reduces the need for rescue treatment and surgical ligation, but has not been proven to improve clinical outcome. The decision to treat the DA depends on the clinician's assessment of clinical and haemodynamic significance and the relative importance placed on reducing the need for rescue treatment and surgical ligation, until larger definitive trials are performed.
