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Am J Perinatol
DOI: 10.1055/a-2685-2169
Review Article

Clinical Impact of the PDA and Its Management on Outcomes of Preterm Infants with NEC: A Review

Vignesh Gunasekaran
1   Department of Pediatrics/Neonatology, West Virginia University School of Medicine, Martinsburg, West Virginia, United States
,
Ricardo J. Rodriguez
2   Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, United States
,
Peter Porcelli
2   Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, United States
,
Nilima Jawale 
3   Department of Pediatrics/Neonatology, SUNY Upstate Medical University, Syracuse, New York, United States
,
Jeffrey Shenberger
4   Department of Pediatrics/Neonatology, Connecticut Children's, Hartford, Connecticut, United States
,
Parvesh M. Garg
2   Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, United States
› Author Affiliations
Funding Information P.M.G. is partially supported by the NIGMS of the NIH under award number U54GM115428. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
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Abstract

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 the increased incidence of patent ductus arteriosus (PDA) in preterm infants less than 32 weeks and in babies with birth weight less than 1,500 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 study, 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.

Key Points

  • • The relationship between PDA and NEC is studied.

  • • The pathophysiology of NEC is described.

  • • Propose future directions for the use of advanced technologies to identify at-risk preterm infants.

Keywords

necrotizing enterocolitis - patent ductus arteriosus - preterm infant

Contributors' Statement

P.M.G. and V.G. designed the study. V.G., P.M.G., N.J., P.P., R.J.R., and J.S. wrote the article. All the authors approved the manuscript.




Publication History

Received: 06 June 2025

Accepted: 18 August 2025

Accepted Manuscript online:
19 August 2025

Article published online:
29 August 2025

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