HEMODYNAMICALLY SIGNIFICANT PATENT DUCT ARTERIUS IN PREMATURE NEWBORN CHILDREN. LITERATURE REVIEW
Introduction. Hemodynamically significant patent ductus arteriosus (PDA) is the most common cardiovascular disease in premature newborns, and remains a frequently discussed issue in neonatology. To this day, there is no clarity in determining the hemodynamic significance of the patent ductus arteriosus, and to this day there is no consensus on this matter. This explains the lack of clear algorithms and certainty in the management of PDA in premature newborns around the world. There are also no clear algorithms regarding treatment, selection of drugs, doses, routes and frequency of drug administration. This often leads to subjectivity in therapy, delays in the start of treatment, and unsuccessful attempts at treatment to close the duct.
Purpose of the study. To review current and relevant research on the management and treatment of patent ductus arteriosus in preterm infants through a literature review.
Search strategy. A search for open access publications was conducted using databases of scientific publications and specialized search engines: PubMed, Google Scholar, Cochrane Library, Scopus, Web of Science. A number of original articles and reviews on the research topic over the past 5 years were analyzed, this is the period 2018-2023, but works published earlier than 2018 were also included, since they have information on the topic under study and the basics of the pathogenesis and pathophysiology of the nasology under study, classical routine approaches to treatment and diagnosis in premature newborns. Key words used: hemodynamically significant patent ductus arteriosus, echocardiography, preterm neonates.As a result of the search, we examined 116 publications, and this review included 82 publications.
Results. In the world on its definition of PDA and management tactics. On the one hand, the qualitative and quantitative determination of the hemodynamic significance of a PDA based on clinical signs, echocardiographic parameters, on the other hand, the determination of clear indications for starting treatment based on the variable parameters for determining the PDA, on the third hand, the determination of the prognosis when a PDA is most likely to have an adverse hemodynamic effect, with the purpose of identifying the category of patients at high risk of serious complications.
Echocardiography (EchoCG) is the “gold standard” in determining the presence of a PDA and its hemodynamic significance. There are echocardiographic indicators that allow one to determine the hemodynamic significance of a patent ductus arteriosus.
Various scoring systems have been developed that integrate risk factors, clinical data, and echocardiographic measurements and have been developed to help the clinician identify PDA and predict outcomes. Although echocardiographic and clinical parameters have been extensively studied, the relationship of PDA with various complications and outcomes requires further research.
Conclusions. Further research is needed to help determine the best clinical strategy to treat hemodynamically significant ductus with maximum safety and effectiveness in neonatal patients. Research is still ongoing to determine the criteria for the hemodynamic significance of patent ductus arteriosus, and treatment issues are also being actively studied.
In addition to clinical assessment, a competent echocardiographic examination of the heart is important for the correct diagnosis of PDA and determination of its hemodynamic significance; Doppler assessment of organ blood flow parameters is especially important for assessing perfusion disorders.
Any type of treatment, both drug therapy and surgical intervention, is imperfect and has its own disadvantages and risks, which are important to remember and make informed decisions when choosing clinical tactics for a newborn patient.
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Omargazina B.S., Chuvakova T.K., Karin B.T., Jaxalykova K.K., Khamidullina Z.G. Hemodynamically significant patent duct arterius in premature newborn children. Literature review // Nauka i Zdravookhranenie [Science & Healthcare]. 2024. Vol.26 (2), pp. 171-183. doi 10.34689/SH.2024.26.2.020Related publications:
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