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首页> 外文期刊>JAMA pediatrics >Diagnosis, Evaluation, and Management of Patent Ductus Arteriosus in Preterm Neonates
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Diagnosis, Evaluation, and Management of Patent Ductus Arteriosus in Preterm Neonates

机译：早产儿动脉导管未闭的诊断，评估和管理

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摘要

Patent ductus arteriosus (PDA) poses a diagnostic and therapeutic dilemma for clinicians. Diagnosis of persistent PDA and determination of its clinical and hemodynamic significance are challenging. Although the condition has been associated with substantial neonatal morbidities such as intraventricular hemorrhage, bronchopulmonary dysplasia, and necrotizing enterocolitis, most therapeutic approaches have failed to show improvement in these outcomes. As such, clinicians have tended toward conservative management strategies; however, the benefits and risks of such an approach are unclear. In this review, we explore various clinical diagnostic modalities, echocardiographic parameters for assessment of shunt presence, shunt volume and its effect on cardiovascular and hemodynamic status, and challenges in determining if a PDA is hemodynamically significant and clinically relevant. From the therapeutic aspect, we review current evidence on conservative, pharmacological, and mechanical (surgical or nonsurgical ligation) approaches to PDA closure. Dose, route, duration, and comparison of pharmacological strategies are reviewed, with implications for future research.
机译：动脉导管未闭（PDA）为临床医生带来了诊断和治疗的难题。持久性PDA的诊断以及其临床和血液动力学意义的确定具有挑战性。尽管该病与大量新生儿疾病如脑室内出血，支气管肺发育异常和坏死性小肠结肠炎有关，但大多数治疗方法均未显示出这些结果的改善。因此，临床医生倾向于保守的管理策略。但是，这种方法的好处和风险尚不清楚。在这篇综述中，我们探讨了各种临床诊断方式，超声心动图参数，以评估分流的存在，分流量及其对心血管和血液动力学状态的影响，以及确定PDA是否具有血液动力学意义和临床相关性方面的挑战。从治疗方面，我们回顾了有关PDA闭合的保守，药理和机械（手术或非手术结扎）方法的最新证据。剂量，途径，持续时间和药理策略的比较进行了审查，对未来的研究有启示。

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