New Treatment Established for Patent Ductus Arteriosus in Extremely Preterm Infants

- Successful Conservative Treatment without Surgery or Medication

- Published in the World-Renowned Journal of Pediatrics


Korean medical researchers announced they could successfully cure extremely premature babies with patent ductus arteriosus (PDA) through conservative treatments instead of traditional medication or surgical methods.


Led by Dr. Park Won Soon, Dr. Chang Yun Sil and Dr. Sung SeIn, the research team from Department of Pediatrics at Samsung Medical Center, Sungkyunkwan University School of Medicine recently published a paper in Journal of Pediatrics, a globally acknowledged journal of pediatrics, showing they have successfully treat PDA in extremely premature infants just by conservative methods including fluid restriction, in which the amount of fluid administered to the baby is slightly decreased, without resorting to traditional methods such as medication or surgery.


While in uterus, a fetus has a blood vessel called the “ductus arteriosus” to maintain blood circulation. In a health full-term birth, the ductus arteriosus is naturally closed as the baby transitions from “fetal blood circulation” to “infant blood circulation.” In a preterm infant, however, the vessel sometimes fails to close and remains open after birth, a condition referred to as PDA.


According to the paper, Dr. Sung’s team compared two groups of 178 extremely premature babies hospitalized at 23 to 26 weeks; one group of 81 infants received medication and surgical treatment between 2009 and 2011, while the other group of 97 babies was treated with conservative methods from 2012 to 2014.


As a result, it was shown that conservative methods alone could lead to natural closure of the ductus arteriosus without medication or surgery, as well as lowering the incidence of bronchopulmonary dysplasia (BPD), a long-term complication from PDA, from 46% to 35%. This is a significant achievement that could change  paradigm in curing the condition in question.


PDA was considered in the past as one of the major causes of death and complications in very premature babies, warranting medication and surgical treatments. Nowadays, however, administering conservative treatment until the ductus arteriosus naturally closes is garnering higher attention, since the causality between the disease and preterm morbidity is regarded as not clearly established and high concerns are raised on the side effects of medication or surgery.


“Inducing the ductus arteriosus to close early on takes a very precise control of the amount of fluid intake in the infant,” Dr. Sung says, “Considering the after-effects of traditional treatments, particularly surgical methods, it is very significant that now we can achieve natural closure of the ductus arteriosus without such invasive treatments.”


Now the neonatal intensive care unit at SMC is striving to improve prognosis in PDA through conservative treatment, while conducting a clinical test that compare conservative methods to medication therapies in terms of safety and efficacy.