Abstract
Aim. The aim of this review study was to explain the consequences of pre-hospital delay in patients with acute myocardial infarction.
Background. Studies have shown that patients with acute myocardial infarction who refer to medical centers late, experience adverse mechanical and electrical consequences of acute myocardial infarction.
Method. In this review study, the keywords Outcome, Myocardial infarction, Delay, and Survival were used to search out the relevant papers published between 2000 and 2020, in databases, Up-to-date, Scopus, PubMed, Science Direct, Web of Science, SID, and Magiran. A total of 14 articles were reviewed.
Findings. The review of the articles showed the consequences of pre-hospital delay in patients with acute myocardial infarction as the following: acute heart failure, cardiac arrest, stroke, mortality, decreased cardiac ejection fraction, long-term hospitalization, decreased long-term survival, increased in-hospital mortality, and increased treatment costs.
Conclusion. Pre-hospital delay in patients with acute myocardial infarction is associated with complications and adverse consequences for patients. Health care team should educate patients and their families about the signs and symptoms of cardiovascular disease and the importance of timely treatment.

Abstract
Aim. This review study was conducted to review the effects, challenges and strategies for providing spiritual care in people with heart disease.
Background. The management of people with heart disease is complex and the course of the disease is unpredictable. The needs of people with heart disease are varied. The available evidence confirms the high level of patients' spiritual needs and desire to receive spiritual care.
Method. In this study, scientific databases and search engines such as Google Scholar, SID, Scopus, PubMed and Web of Science were used to find papers published between 2000 and 2020. The keywords included spiritual care, cardiac disease, cardiac patient, heart disease, coronary artery disease and their Persian equivalents. The selected articles for review were those in Persian or English language and about spiritual care and people with heart disease that their full text were available.
Findings. A total of 27 articles were reviewed. The spiritual needs of people with heart disease, the effect of spiritual interventions in reducing the symptoms of these patients and the problems of achieving this goal and the way to solve them were reviewed.
Conclusion. Spiritual care in patients with heart disease improves quality of life, spiritual well-being, reduces anxiety and depression; therefore, it is necessary to include spiritual care in the usual care of people with heart disease.

Abstract
Aim. The aim of this study was to review studies that investigate the factors affecting adherence to treatment in people with cardiovascular disease.
Background. Adherence to treatment is a comprehensive term that is used to convey acceptance of treatment process and following professional advice by the patient to increase the quality of life. Given the importance of adhering to treatment plans and being aware that many people do not follow treatment plans, understanding the factors that lead to patients' effective adherence to the treatment regimen can lead to the development of strategies to increase patients' adherence to the therapeutic regimen.
Method. Articles published between years 2010-2020 were searched out in databases Science Direct, PubMed, Cochrane, Medline, SID, Scopus, CINAHL, OVID, Iran Doc and Magiran using the keywords adherence to treatment, cardiovascular diseases and their Persian Equivalents. Research articles in Persian and English focusing on the factors affecting the adherence to treatment in cardiovascular patients were selected for the study. In total, 167 articles were found in primary search by reviewing the title and abstract and in some cases after studying the full text of the articles; out of them, 11 were selected that were in accordance with the research purpose of this study.
Findings. The most effective methods for improving adherence to treatment were tele-nursing and educating colleagues on how to follow up patients. Also, recognizing differences between personal and psychological aspects of patients and adopting an appropriate method for each person to pursue treatment and increase adherence to the treatment regimen are very important known factors in the care of cardiovascular patients.
Conclusion. In general, the care and training provided and continuous follow-up by the health care professionals have the greatest impact on increasing adherence to the treatment regimen among patients.

Abstract
Aim. The aim of this study was to compare the effect of two high intensity interval training (HIIT) protocol on plasma levels of adiponectin, leptin and hypertension in overweight nurses.
Background. Cardiovascular disease, as a chronic and debilitating physical condition, is one of the most common causes of death worldwide and can affect the health of individuals, especially nurses who are exposed to a variety of diseases and it is necessary to identify variables related to health in these group.
Method. This was a clinical trial in which 27 nurses (mean age 25.81±0.6 years, mean height 158.01±7.6 cm and mean weight 69.41±0.25 kg) were selected and randomly divided into three groups of high intensity interval training type 1 (8 seconds of fast running and 12 seconds of active recycling), high intensity interval training type 2 (40-meter sweep test with maximum speed), and control group. High intensity interval training type 1 was performed for four weeks, three sessions per week, each session lasted 6-9 minutes with more than 90% of maximum heart rate. High intensity interval training type 2 was performed for four weeks, three sessions per week, with more than 90% of the maximum heart rate. The control group did not participate in any training program.
Findings. The study showed that HIIT type 1 and type 2 had a statistically significant effect on reducing plasma leptin levels, systolic and diastolic blood pressure and increasing plasma adiponectin concentration in nurses. Both training methods improved health indicators (adiponectin, leptin and systolic and diastolic blood pressure), but HIIT type 1 training caused more control and regulation of these indicators compared with compared to HIIT type 2.
Conclusion. There is a significant difference between type 1 HIIT exercise, type 2 HIIT exercise and control in research variables (adiponectin, leptin and blood pressure) in nurses.

Abstract
Aim. The present review study was conducted with the aim of exploring what nurses should know about interactions of diet containing vitamin K with warfarin.
Background. Warfarin is one of the most widely used oral anticoagulants. Dietary interactions, mainly due to vitamin K, are a common concern when consuming warfarin. In the meantime, the nurse, as the first person in the care chain and the main person in charge of patient education, can play an important role in reducing these interactions, which is a challenge for patients.
Method. The present review study was conducted through searching out library as well as databases such as PubMed, Cochrane Library, Web of Science, Scopus, Up-to-date, OVID, CINAHL, Magiran and SID using Persian keywords of warfarin, dietary interactions, vitamin k diet, patient and nurse education and their English equivalents in the period 1999 to 2021. Out of a total of 30 articles found, 8 articles were reviewed after screening the articles.
Finding. The findings of this study showed that the amount of vitamin K intake in the diet should be kept constant. This is 90 to 120 micrograms per day. Patients should be properly and continuously educated about vitamin K in various foods and supplements. In the meantime, the role of the nurse as one of the pillars of patient education is very important and fundamental.
Conclusion. Due to the role of the nurse in educating these patients, it is recommended that education about dietary interactions be used using authoritative sources. It is possible with methods such as preparing a clinical guide, making a video and designing an application, and including tables of vitamin K levels in foods.

Abstract
Aim. The aim of this study was to review the cardiovascular disorders and complications caused by COVID-19.
Background. Coronavirus (COVID-19) disease is a viral disease caused by the SARS-CoV-2 virus. The virus was first discovered in Wuhan, China, and was declared a global pandemic due to its widespread prevalence. So far, about 500 million cases of and 6 million deaths from the disease have been reported worldwide. SARS-CoV-2 mainly causes respiratory problems, and fever, cough, shortness of breath, myalgia, fatigue and diarrhea are common symptoms of the disease. COVID-19 also causes cardiovascular disorders, which due to the importance of the impact of these disorders on the health of people in the community, in this article, studies and research conducted in this field were reviewed.
Method. The keywords “Covid-19”, “Coronavirus”, and “Cardiovascular complication” were searched out in databases, Web of Science, Scopus, PubMed, and Google Scholar. Out of 84 articles that were found the more relevant ones to the research topic were selected. After reviewing the studies thoroughly, 33 papers that were in line with the purpose of the study were selected and reviewed.
Findings. Studies and findings have shown that COVID-19 can cause cardiovascular complications such as cardiac arrhythmias, acute coronary syndrome, acute myocardial injury, myocarditis and heart failure.
Conclusion. Given the prevalence of COVID-19 and its high prevalence worldwide, it is important to be familiar with the cardiovascular disorders caused by the disease and how to treat and manage these disorders.

Abstract
Aim. The purpose of this study is to review studies that have investigated the effect of CardioPulmonary Cerebral Resuscitation (CPCR) training on nurses' knowledge and performance.
Background. CPCR is a systematic procedure and a set of targeted measures have been used by nurses to restore the vital functions of the body's central organs, such as the heart, lungs, and brain. The application of teaching is a suggested method for improving the knowledge and skills of nurses PCPR in most published articles. 
Method. In this r eview study, a comprehensive search of scientific databases and sear ch engines such as Science Direct, PubMed, Cochrane, Medline, SID, Scopus, CINAHL, OVID, Iran Doc and Magiran using the keywords cardiopulmonary resuscitation, nurses, practice, knowledge in both Persian and English languages was done to find articles published between 2010 and 2022.
Results: CPCR training in both face-to-face and virtual form can be effective on the knowledge and performance of nurses, and in all studies there was a significant relationship between the scores before and after the training. The implementation of these trainings should be repeated for nurses permanently and every six months.
Conclusion: Basic training can lead to increasing the knowledge of nurses in the field of basic and advanced cardiopulmonary resuscitation. Based on this, regular theoretical and practical workshops and training courses are recommended.

Abstract
Aim. The purpose of this study is to review studies that have investigated the effect of family-centered self-care program on the activity of people with cardiovascular disease after hospital discharge.
Background. Adherence to medication, diet and physical activity in people with cardiovascular disease is very crucial to prevent readmission, independence in daily activities, and complications.
Method. In this review study, a comprehensive search of scientific databases and search engines such as Science Direct, Scopus, PubMed, Google Scholar, and Medline using the keywords cardiovascular disease, adherence to treatment regimen, and family-centered self-care program in both Persian and English languages was done to find articles published between 2000 and 2020.
Findings. Family-centered post-discharge self-care program can be a principled and effective method to increase adherence to medication, diet and physical activity in heart people with cardiovascular disease.
Conclusion. One of the most important factors in effectiveness of self-care is active family participation and family-centered self-care, which can be effective in three areas after the discharge of people with cardiovascular disease.

Abstract:
Aim. The aim of this article is to review studies that have evaluated effective interventions in the prevention of mediastinitis following cardiothoracic surgery.
Background. Mediastinitis and deep surgical wound infections (DSWI) are life-threatening complications of median sternotomy and have a prevalence of 0.4-5 percent. They can produce a significant financial burden on the patient and also the health care system by prolonging the hospitalization period and the need for repeated surgeries or long-term antibiotics. Several risk factors have been identified for mediastinitis following cardiothoracic surgery, many of which are easily preventable by proper diagnosis.
Method. In this literature review, databases including PubMed, Medline, UpToDate, Scopus, Science
Direct, SID, and Magiran were searched out using the keywords Mediastinitis, Prevention, Cardiothoracic
surgery, and their Persian equivalents. Persian and English original articles (including cross-sectional, case- control, cohort studies, and clinical trials) investigating the effective interventions in the prevention of me- diastinitis following cardiothoracic surgeries and were published between 2000 and 2021 and had an available full text, were included in the current study; review articles, letter to editors, and case reports published in non-authoritative journals were excluded from this study. After primary search, 62 relevant articles were found and based on inclusion/exclusion criteria, 16 articles were finally selected and reviewed in the cur- rent study.
Findings. Mediastinitis ca n be prevented before surgery by hand hygiene, weight loss, smoking cessa-tion, proper prophylactic antibiotics, decolonization of nasopharynx and oropharynx from Staph aureus by Mupirocin ointment, and removing hair using depilatory cream (not the blade). Tight blood glucose monitoring before, after, and during the surgery, disinfection of the surgical field by chlorhexidine, using a proper surgical technique for wound closure and stabilizing the sternum, and proper patient training by nurses about red flags of infection can play an important role in the prevention of mediastinitis.
Conclusion. Mediastinitis ca n be easily prevented by identifying its risk factors and controlling them accurately and in a timely manner.

Abstract
Aim. This review discusses the studies that have investigated the effect of cardiac rehabilitation programs on people with Covid-19.
Background. It has been previously revealed the profits of cardiac rehabilitation for patients who suffer from cardiovascular diseases. With the occurrence of the covid-19 pandemic, many have suffered from cardiovascular complications due to the coronavirus infection. Despite the application of many medications and therapeutic interventions to control the side effects, many are still experiencing the secondary complications of the disease, specifically the cardiovascular complications, and the search for an effective solution continues. The use of cardiac rehabilitation for these patients may be effective.
Method. A broad search was conducted in scientific databases and search engines such as Science Direct, PubMed, Cochrane, Medline, SID, Scopus, CINAHL, OVID, Iran Doc, and Magiran with the keyboards “Covid-19”, “post covid-19 period”, “cardiac rehabilitation” and “rehabilitation” in both English and Persian language journals published between 2000 and 2022. After a comprehensive review, nine studies that met the purpose of this study were selected.
Findings. Cardiac rehabilitation programs decrease complications, mortality, and readmission of people with Covid-19, and modify the signs, physical and cardiovascular functions, and the quality of life in these patients.
Conclusion. For finer efficacy of cardiac rehabilitation programs, designating a program suited for the patient's condition, schedule adherence, and evaluation of the findings should be considered. It seems that cardiac rehabilitation programs can be beneficial for people with Covid-19 in reducing complications and mortality rates. More studies are needed for more information.

Abstract
Aim. This review study was conducted with the aim of highlighting the importance of a preoperative preventive approach in the recovery of patients undergoing coronary artery bypass surgery.
Background. With the increase in the number of patients who are candidated for heart surgery, improving the health status before the operation is of great importance to optimize the results after the operation. This review has been conducted with the aim of evaluating the evidence related to the pre-rehabilitation of patients undergoing coronary artery bypass surgery.
Method. The present literature review was conducted by searching out library resources and databases, Scopus, Chochrane Library, Magiran, SID, PubMed, Up-to-date, OVID, CINAHL, and Web of Science with the keywords, coronary artery bypass surgery, pre-rehabilitation, cardiovascular disease and their Persian equivalents without time limit. From a total of 104 articles, 63 full texts articles entered the review stage, of which 17 articles entered the literature review.
Findings. The findings indicate the favorable effects of pre-rehabilitation on improving the quality of life and preventing complications in the early postoperative period. Pre-rehabilitation programs should adopt multifaceted approaches including nutrition, exercise, and anxiety reduction to improve patient resilience in the preoperative period. The pre-operative period is a critical opportunity to implement pre-rehabilitation interventions for vulnerable patients awaiting cardiac surgery.
Conclusion. Cardiac pre-rehabilitation includes a wide range of preventive interventions that can be taught by nurses to patients undergoing cardiac surgery. Pre-rehabilitation requires an interdisciplinary approach, because it suggests a change from the current model of health care and transformation from one-dimensional care to interdisciplinary care, which can be an effective tool for the medical and nursing system in timely identification of physical and mental disorders in initial preoperative assessment, preoperative education and management, as well as prevention of postoperative complications.

Abstract
Aim. This literature review was conducted to investigate determinants of readmission among Iranian people with heart failure.
Background. Heart failure (HF) as a chronic progressive syndrome may reduce the quality of life and increase their treatment costs. The rate of readmission is relatively high in these patients, presenting a major health problem.
Method. In the present literature review, the literature on the topic were searched out in databases PubMed, Google Scholar, Web of Science, ProQuest, Magiran, SID, and IranMedex. The terms heart failure, congestive heart failure, readmission, rehospitalization, and Iran were searched without time limit. Literature search and evaluating the articles were independently conducted by two researchers, and all eligible studies were included in the review process.
Findings. Out of 601 studies found in the initial search, seven articles meeting the inclusion criteria entered the final phase of the study and were reviewed. According to these studies, the readmission rate varied from 10.9 to 40 percent. Some of the important factors affecting the readmission rate in patients with heart failure included age, gender, education, job status, underlying disease, disease stage, poor adherence to the therapeutic regimen, insurance coverage status, and place of residence.
Conclusion. Based on the results of the present study, the rate of readmission was high among Iranian patients with heart failure. It is recommended to consider interventions such as educational programs to improve patients’ awareness about this condition and their adherence to self-care activities.

Abstract
Aim. In this review article, the cost-effectiveness of disposable suction bottles in Iran was discussed.
Background. Healthcare-associated infections (HAIs) cause mortality and morbidity in patients, especially in the intensive care unit. There are different methods and instructions to control HAI, which is an important and fundamental problem related to suction.
Method. Searching out for articles through databases including Science Direct, PubMed, Cochrane, Medline, SID, Scopus, CINAHL, OVID, Iran Doc and Magiran using the keywords "disposable suction", "hospital infection", "waste management" and their English equivalent were conducted. Articles that were published between 2000 and 2022 and were more related to the main focus of the research topic were selected. The inclusion criteria included their publication in reputable scientific journals, publication in Farsi or English, and access to the full text of the article. Exclusion criteria included publishing articles in weak and invalid journals.
Findings. Disposable suction bottles was evaluated in five domain including hospital infection control and prevention, water consumption management, ease of use, waste management, and cost effectiveness.
Conclusion. Considering the lack of manpower for disinfecting disposable suction bottles, the costs of disinfectant solutions and their improper use in diluting them, and the management of waste water from used solutions and emptying suction cups; disposable suction bottles have priority over reusable suction bottles in Iran.

Abstract
Aim. This paper aims to investigate barriers and opportunities of the virtual visiting in intensive care unit during Covid-19 pandemic.
Background. Face-to-face visits of hospitalized patients in intensive care units reduce separation anxiety and stress caused by hospitalization, as well as increase the feeling of comfort and safety in patients. In addition, it is the key to patient/family-centered care. However, the Covid-19 pandemic and its related restrictions ruled out the possibility of using the family's potential and providing patient/family-centered care. Virtual visiting has been proposed as a solution to remove the family's distance from the patient.
Method. This review was conducted by searching out databases, Web of Science, Scopus, PubMed, Magiran, SID and Cochrane with the keywords, Covid-19, Video calls, Family-patient center care, Intensive care unit, and Virtual visiting without time limitation. The inclusion criteria were the publication of the article in Persian or English language and the availability of the full text of the articles. In total, 45 articles were found, most of which focused on virtual appointments and virtual patient visits by physicians. After removing irrelevant papers, and the cases without full text, 29 articles were evaluated in terms of quality. Finally, 10 articles were evaluated in terms of subject, and the purpose related to the present study.
Findings. During Covid-91 pandemic, virtual visits were done in intensive care units in most medical centers using cell phones and tablets through social networks facilities. In all cases, families and health care providers were satisfied with this communication method, but they considered it was not a suitable substitute for face-to-face meetings. They believed that this method combined with face-to-face meetings would be more effective. Lack of regular and systematic planning, ambiguities in the duties of health care providers in the field of holding virtual visiting, lack of access to the internet at a suitable speed, and the complexity of working with smartphones for some families, were barriers of this method.
Conclusion. Virtual visiting provides a form of presence for families who are far away from their patients. Via this method, not only one but also all the family members can visit the patient. Although this method did not affect the stress and anxiety of the family and patients, but it was able to create a positive experience for them during hospitalization in intensive care units. Moreover, by involving the family in treatment process and informing them opens the ways to reach the patient/family-centered care in intensive care units.

Aim. The present study was conducted with the aim of reviewing the role of serum albumin in heart failure.
Background. Heart failure is a complex clinical syndrome that affects a large population worldwide yearly, and its mortality is even higher than that of many cancers. Although the identification of traditional risk factors has helped in primary prevention, the death rate due to this disease is still increasing. Identifying potential and modifiable risk factors that are not known yet seems necessary in this situation. Serum albumin has been known for many years as a strong prognostic biomarker in many pathological conditions. In recent years, studies have been conducted regarding the role of serum albumin in the prediction, prognosis and treatment of heart failure symptoms.
Method. This narrative study was conducted in 2023. For this purpose, the data bases, PubMed, Scopus, Web of Sciences, SID, MagIran were searched out with the keywords albumin, heart failure, diastolic failure, systolic failure, and a total of 30 articles were included in the study.
Findings. Hypoalbuminemia is a common finding in patients with heart failure, and among its main causes in heart failure are malnutrition, inflammation, lack of intestinal function, lack of kidney function, and liver disease. According to clinical and experimental evidence, hypoalbuminemia is related to fluid retention and exacerbation of pulmonary edema in these patients. Also, hypoalbuminemia can independently predict the onset of a new heart failure and can be measured as a prognostic factor of heart failure outcomes. However, there is still no evidence that directly shows the benefit of albumin injection in patients with heart failure.
Conclusion. Serum albumin can be measured as a modifiable risk factor and a prognostic factor in heart failure, but it is necessary to limit its use to cases where its effectiveness has been confirmed.

Abstract
Aim. This study was conducted with the aim of providing care solutions to manage the hemodynamic status of potential donors with brain death.
Background. Currently, organ transplantation is the treatment of choice for complete organ failure. The results of studies have shown that a significant percentage of potential donors with brain death organs are not usable for transplantation due to hemodynamic instability. Therefore, hemodynamic management in this category of donors plays an essential role in the donation process. Despite the studies, there are no strong evidences and recommendations about the management of hemodynamic stability of these patients. Therefore, in this review, evidence-based solutions have been tried to maintain the hemodynamic stability of these donors.
Method. In this review study, with library search and search in databases PubMed, Scopus, Web of Science, SID, and MagIran with the keywords organ donor management, brain death, hemodynamic care, organ donor, deceased donor, hemodynamic management, donation after neurological death, and cardiovascular management published in the period from 2009 to 2024. In addition, the Google Scholar search engine was also explored. A total of 20 articles were included in the literature review.
Findings. Maintaining proper organ perfusion and identifying clinical conditions that can be effectively treated are among the most important goals of hemodynamic management of these donors, and hemodynamic monitoring, serum therapy, use of cardiac drugs, and hormone therapy are among the most important. There are also studies that recommend serial echocardiography to identify reversible clinical conditions.
Conclusion. The high demand for organ transplantation, and despite the high number of brain deaths and sometimes consent for transplantation, only a small percentage of these people's organs are successfully transplanted. In order to preserve the transplanted organs, it is recommended to take proper and basic care of the patients with brain death. It is necessary for nurses, especially nurses in the intensive care unit, to be very careful in caring for patients with potential brain death.
 

Abstract
Aim. The present study was conducted with the aim of reviewing the effect of telenursing in the care of patients with heart failure.
Background. Heart failure is one of the most common cardiovascular diseases, which is presented as a progressive and debilitating disorder. The prevalence of this disease is increasing due to the increasing age of the population, recent advances in the treatment of myocardial infarction, congenital diseases and the decline in mortality. In Iran, approximately one percent of all people over 40 years old have heart failure. The prevalence of this disease doubles with every decade of life and reaches about 10 percent in people over 70 years old. Studies have shown that specialized disease management programs for chronic heart failure (CHF) improve survival and quality of life and reduce health care utilization. Telenursing is one of the existing models.
Method. The present study is a narrative review. The researchers searched out the databases and search engines PubMed, Scopus, Web of Science, SID, Magiran, and Google Scholar using the keywords, care, chronic heart failure, nurse, telenursing and their Persian equivalent. After checking out the title and abstract of the articles found using the Joanna Briggs Institute (JBI) tool, the researchers reviewed 10 articles in this study.
Findings. Telenursing reduces hospitalization due to heart failure, reduces mortality and improves quality of life in patients with heart failure and improves education and follow-up after discharge. It also improves disease outcomes and reduces health costs.
Conclusion. The importance of paying attention to telenursing is recommended to policy makers and decision makers in the health system. 

Abstract
Aim. This study was conducted with the aim of identifying different educational approaches to self-care and their outcomes in elderly patients with hypertension.
Background. The increase in life expectancy and decrease in fertility rates have led to a growth in the elderly population worldwide. High blood pressure, one of the most common chronic diseases among the elderly, is on the rise. Engaging patients in self-care activities is considered as an effective way to control high blood pressure, requiring a shift in patient understanding, attitude, and education.
Method. This review was conducted using searching out the keywords, self-care, elderly, high blood pressure, hypertension, and patient education in databases, Web of Science, Scopus, SID, MagIran, PubMed, and Google Scholar from 2010 to 2024. Inclusion criteria consisted of articles published in Farsi and English with full-text availability, resulting in the evaluation of 14 articles.
Findings. The study revealed that education based on various approaches such as health belief, common sense, interactive and blended, Leventhal, multimedia, and virtual space had a positive and significant impact on blood pressure control. However, the specific approach with the most impact remains unclear, though studies suggest the health belief model has a greater influence.
Conclusion. Based on these findings, it is recommended that patient education is conducted based on educational approaches and self-learning models. This recommendation should be considered by hospital patient education units and nurses.

Method. This literature review was conducted through a systematic and targeted search of articles and texts published from 2008 to 2024 in PubMed/, Web of Science, Google Scholar, and Scopus using the keywords Patent ductus arteriosus, Infant, Nursing care, Treatment, and their Persian equivalents.

Findings. Twelve articles and one book were found and the findings were organized as definition and pathophysiology of patent ductus arteriosus, diagnoses. treatment options, and nursing care.
Conclusion. The transition of the fetus from the womb to extrauterine life is one of the dynamic and vital adaptations in the life of neonates, especially premature neonates. With comprehensive monitoring and skillful clinical assessment, patent ductus arteriosus in neonates can be better managed.