Management of patent ductus arteriosus in preterm infants: Abundant literature, low certainty of evidence for clinicians.

Management of patent ductus arteriosus (PDA) in preterm newborns has been debated extensively for more than six decades. Some authors affirm that PDA is only an innocent mirror of infant immaturity, without specific health consequences. They also underline the futility, even danger, of treating it. Others are concerned about the hemodynamic effects of this left-right shunt, resulting in high pulmonary blood flow and low systemic output, which can contribute to the occurrence of severe morbidities - including pulmonary hemorrhage, intraventricular hemorrhage, bronchopulmonary dysplasia and necrotizing enterocolitis -and may increase the risk of death. Many management strategies have been described, ranging from expectant management to nontargeted prophylaxis, but there is currently no consensus about who to treat, when, and how.