Clinical impact of the PDA and its management on outcomes of preterm infants with NEC – A review

Necrotizing enterocolitis (NEC) is one of the most common gastrointestinal emergencies in preterm infants. The pathogenesis of NEC is not clearly established and multifactorial. Preterm infants are at increased risk for NEC because of intestinal immaturity resulting in potential mucosal injury. Circulatory instability has been proposed as a key indicator for ischemic insult to the gut leading to NEC. With increased incidence of patent ductus arteriosus (PDA) in preterm infants less than 32 weeks and in babies with birth weight less than 1500 g, several studies propose an association of NEC with a hemodynamically significant PDA. This review provides an extensive literature search for NEC and PDA in the PUBMED database. In this article, we will review the pathogenesis of NEC and the relationship between PDA and NEC. We will also explore the different treatment options for PDA and their relationship to the incidence of NEC. While earlier diagnosis and aggressive treatment of NEC have improved the outcomes, the disease still accounts for 10% of deaths in infants in the neonatal intensive care unit. With resuscitation of increasingly earlier gestational age infants, the incidence of both hemodynamically significant PDA and NEC is rising, denoting the importance of understanding the inter-relationship of these two pathophysiological processes.

Publication History

Received: 06 June 2025

Accepted after revision: 18 August 2025

Accepted Manuscript online:
19 August 2025