If a baby is less than 27 weeks gestation and there is echocardiographic expertise available, it is reasonable to treat a duct on this basis. There is some evidence that a targeted early approach improves pulmonary outcomes 17 but more study is needed on the effects on other outcomes. This is the established approach which minimises exposure to indomethacin. The National Collaborative PDA trial 11 showed less complications from this approach but no advantage in terms of long term outcomes. Key Points Risk of PDA increases with lower gestation.
Early diagnosis requires high degree of suspicion and echocardiography.
Indomethacin is first line treatment with surgery if that fails. Targeted early treatment or treatment of a symptomatic PDA is justified. More evidence is needed to support prophylactic use of indomethacin. Postnatal circulatory adaptation in healthy term and preterm neonates. T, Bancalari E. Lung compliance in newborns with patent ductus arteriosus before and after surgical ligation.