Neonatal Nurse Practitioner NCC Practice Exam

When a patent ductus arteriosus is hemodynamically significant, the usual first-line approach is medical closure using nonsteroidal anti-inflammatory drugs like indomethacin or ibuprofen. These medications inhibit cyclooxygenase, which lowers prostaglandin E2 levels that normally keep the ductus arteriosus open. With reduced prostaglandins, the ductus constricts and closes, addressing the root cause and often avoiding surgery. If NSAIDs are contraindicated (for example, due to renal issues or risk factors for necrotizing enterocolitis) or if the ductus remains open after a course of medical therapy, surgical closure becomes the next step. This can be achieved by ligation or, in some centers, transcatheter closure. Other options don’t close the defect themselves. Observation alone is not appropriate when the PDA is causing significant symptoms, and high-dose diuretics only manage fluid overload without addressing the underlying ductal patency.