About this Research Topic
Ductus arteriosus is a vital fetal shunt which should be closed after birth. However it remains open in more than half of small preterm infants and when it becomes hemodynamically significant (hsPDA) with left-to-right shunting which results in pulmonary hyperperfusion and systemic hypoperfusion. Although any evidence for a causal relationship is lacking, may have an impact on common morbidities such as bronchopulmonary dysplasia (BPD), pulmonary hemorrhage (PH), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), retinopathy of extreme prematurity, neurodevelopmental impairment and eventually mortality.
Despite our expanding knowledge about the problems of small preterm infants, management of Patent Ductus Arteriosus (PDA) is controversial. Much debate exists on clinical and echo definition of hsPDA, selecting the infants that will mostly benefit from treatment, timing and options of treatment and the outcomes associated with PDA and its therapies.
There are several simple bedside questions to be answered. Such as: Is there a short term and long term decisiveness of the present ductus in the health of this individual preterm patient? Is this a stage at which the physiological effects of the shunt changes from benefit to harm? Although many strategies for management of the consequences of PDA have been proposed, new clinical trials are needed to guide diagnosis and management of these infants.
This Research Topic will provide current basic and useful knowledge on PDA of small preterm infants. We welcome both experimental and clinical research articles about pathophysiology, diagnosis and treatment of PDA that provide further insight for the scientists and clinicians caring for health and diseases of preterm infants.
Epidemiological Studies, Observational Studies, Case Series, Randomized Controlled Trials about management approaches and complications of particular drug treatments of PDA are in the scope of this Research Topic. We also aim to collect reports on interventional catheter treatment and new drug treatments.
Sub-themes that we would wish to explore in this Research Topic includes:
• Epidemiology, incidence, screening of PDA;
• Pathophysiology of PDA;
• Role of echocardiography, biochemical markers and clinical signs in the diagnosis of PDA;
• Clinical scoring systems;
• Diagnostic techniques about hemodynamic significance of the ductus;
• Treatment strategies including conventional and new drugs;
• Identifying candidates for conservative management. Conservative management represents the bedside interventions including fluid restriction, setting ventilator and treating sepsis etc. other than drug and surgical interventions. In this approach we let the ductus stay open without giving ıbuprufen, indomethacin, Paracetamol, catheter or surgery. İt is watchful wait and see;
• Tools for decision making on treatment modalities;
• Surgical management of PDA;
• Effects and side effects of medical and surgical treatment;
• Outcomes of the treatment in relevance with BPD, mortality and neurodevelopmental outcomes;
• Advances in management of PDA: transcatheter closure PDA in preterm infants.
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Keywords: Patent ductus arteriosus, preterm infant, diagnosis, management, outcome
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