Abstract
Opinion on the importance of the preterm persistent ductus arteriosus (PDA) has swung between being viewed as the cause of most preterm adverse outcomes to being viewed as an innocent physiological bystander. The former view derives from observational studies of the pathophysiology of the PDA [1, 2] and statistical associations with adverse outcomes [3]. The „innocent bystander“ view derives from the amalgamation of historically and methodologically diverse randomised trials [4–6]. These reviews show little evidence of consistent effect on outcomes of treating PDA leading to conclusions that if treating makes no difference to outcomes then PDA may not be pathological for the preterm infant. While this is one possible conclusion, there are other equally valid ones, specifically whether we have really understood what is going wrong and whether we have asked the treatment questions in the correct way? While systematic review is good at defining the limits of our understanding, it paints pictures with too broad a brush to allow definition of which questions should be asked and how we should ask them. For that there is no substitute for looking at the babies and their ducts so we can understand what is physiological and what is pathological. To do this you need ultrasound.
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Evans, N. (2011). Echocardiographic Assessment of the Patent Ductus Arteriosus in the Preterm Infant. In: Controversies around treatment of the open duct. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-20623-8_3
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DOI: https://doi.org/10.1007/978-3-642-20623-8_3
Publisher Name: Springer, Berlin, Heidelberg
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