Management Of Patent Ductus Arteriosus

Yıl 2017, Cilt: 9 Sayı: 4, 33 - 37, 20.07.2017

Uzm. Dr. Emel Okulu

Öz

Abstract

Although it is known that patent ductus arteriosus (PDA) is associated with neonatal morbidities such as intraventricular hemorrhage, bronchopulmonary dysplasia,and necrotizing enterocolitis, most therapeutic approaches have failed to show improvement in these outcomes. During the last years therapy for PDA has gone thro-ugh a full circle from conservative therapy to aggressive medical and surgical therapy and back to conservative management. There is no consensus regarding whomto treat, when to treat, and how to treat. Further studies are needed for both diagnosis and treatment that take into account modern practices, including antenatal corticosteroid use, minimally invasive respiratory support, and minimal oxygen on day 2 or 3 after birth. For diagnosis, comprehensive risk assessment tools are needed that include patient characteristics, ductrelated variables, parameters incorporating effects of the duct on other organ systems, and echocardiographic markers at the time of decision making. From a treatment perspective, multicenter randomized studiesare required to evaluate the long-term cardiovascular, respiratory, and neurodevelopmental outcomes of conservative, prophylactic, early asymptomatic and symptomatic treatment, and different theurapatic agents.

Anahtar Kelimeler

patent ductus arteriosus, treat-ment, preterm infant

Patent Duktus Arteriyozus Yönetimi

Öz

Öz

Patent duktus arteriyozusun (PDA), intraventiküler kanama, bronkopulmoner displazi, nekrotizan enterokolit gibi yenidoğan morbiditeleri ile ilişkisinin bilinmesinerağmen, tedavi yaklaşımlarının bu komplikasyonları önleyemediği gösterilmiştir.PDA’ya yaklaşım, yıllar içinde konservatif tedaviden agresif medikal ve cerrahi tedaviye kaymışken, günümüzde tekrar konservatif tedavi ağırlıklı bir yaklaşım ağırlık kazanmaya başlamıştır. PDA’nın hangi bebekte, ne zaman ve nasıl tedavi edileceği konusunda görüş birliği bulunmamaktadır. PDA tanısı ve tedavisine yönelik, antenatal steroid kullanımı, minimal invaziv solunum desteği, doğumdan sonraki ikiveya üç günde minimal oksijen kullanımı gibi güncel yaklaşımları da içeren daha fazla çalışmaya ihtiyaç duyulmaktadır. Tanı için, hasta özelliklerini, duktus değişkenlerini, duktusun diğer organlara etkisini gösteren parametreleri ve karar anında ekokardiyografi bulgularını içeren, risk değerlendirme ölçekleri geliştirilmelidir. Tedavi için, konservatif, profilaktik, erken semptomatik ve semptomatik tedavinin, fark-lı ajanların uzun dönem kardiyovasküler, solunum ve nörogelişimsel sonuçları ile de-ğerlendirildiği randomize çok merkezli çalışmalara gereksinim bulunmaktadır.

Anahtar Kelimeler

patent duktus arteriyozus, tedavi, prematüre

Kaynakça

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