Patent Ductus Arteriosus: Optimal Fluid Requirements in Preterm Infants

Fluid management of preterm infants who have suspected or confirmed patent ductus arteriosus (PDA) can be challenging. It is vital for clinicians to understand fluid and cardiovascular changes that occur at birth and during PDA management to gain a better appreciation of the pathologic processes that could influence the clinical course of an affected infant. Furthermore, knowledge of current and effective treatment strategies is important to provide optimal care for this cohort of fragile infants. The aims of this review are to: 1) Determine the relationship between fluid management and PDA-related morbidities such as renal failure and intraventricular hemorrhage, duration of oxygenation, mechanical ventilation, and hemodynamic stability from the available scientific literature; 2) Assess the effects of fluid restriction in preterm infants who have suspected or confirmed PDA; and 3) Develop guidelines for fluid management once a decision is made to intervene medically or surgically. Based on the available evidence, we propose guidelines for fluid management of a hemodynamically significant PDA (HSDA) during treatment and through the neonatal course following postoperative ductal ligation.