Patent Ductus Arteriosus
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Condition: Patent Ductus Arteriosus (PDA)
Overview (“What is it?”)
- Definition: The ductus arteriosus is a connection between the aorta (large blood vessel that carries blood to the entire body) and the pulmonary artery (blood vessel that carries blood to the lungs). This is a structure that is very important while the baby is developing inside the mother, because through it, the mother provides oxygen to the baby. When the baby is born, the baby starts breathing and the ductus arteriosus is not needed anymore. Normally it closes on its own after birth. Sometimes, especially in premature babies, the ductus stays open (“patent”)—thus, the condition is named “patent ductus arteriosus” (PDA). Blood that is supposed to go to the body will instead go to the lungs. This situation can cause too much blood to go to the lungs, requiring the baby to remain on the ventilator for a long time.
- Epidemiology: Happens in 7-38% premature babies
Signs and Symptoms (“What symptoms will my child have?”)
- Early signs
- Murmur heard on exam
- Needs oxygen
- Blood pressure changes
- Later signs/symptoms
- Congestive heart failure—heart needs to work harder and over time, it may not be able to keep up
- Need to be on the ventilator a long time
- Murmur heard on exam in older kids
Diagnosis (“What tests are done to find out what my child has?”)
- Labs and tests
- Exam: Murmur heard with stethoscope
- Chest X-ray: Findings of an enlarged heart or fluid in the lungs
- Echo (ultrasound of the heart) shows the presence and size of the PDA and the flow of blood in PDA
- Conditions that mimic this condition
- Lung disease due to prematurity (bronchopulmonary dysplasia)
- These babies will also have lung problems requiring ventilator but no murmur or PDA seen on echo.
Treatment (“What will be done to make my child better?”)
- There are medicines that can be given to help close the ductus. Indomethacin and acetaminophen are two of these medications.
- Risk of indomethacin includes association with intestinal perforation, bleeding and kidney abnormality.
- Surgery is the only option if the baby fails medical therapy or if complications happen because of the medicines given to close the ductus.
- Can be done in the operating room or in the neonatal intensive care unit (NICU)
- Left thoracotomy (incision on side of left chest between ribs)
- Place clip on PDA to close it
- Older children can have PDA closed by placement of coils in PDA by accessing it using catheters through the artery in the groin (transcatheter coil embolization).
- Preoperative preparation: Antibiotics are given by vein to decrease risk of infection.
- Postoperative care
- Chest X-ray after surgery
- Supportive care (fluids, possible blood pressure medication, ventilator, pain medication) after surgery. It will take some time for the baby to recover from surgery and get used to new blood circulation.
- A small tube may be placed in the chest cavity after the surgery to drain extra air and fluid. This will be removed a few days after the operation.
- Damage to lung (low)
- Damage to nerve (recurrent laryngeal nerve) which can affect vocal cord on left side. Voice is preserved, but may have swallowing problems.
- Death (low incidence but can happen due to bleeding)
- Improve baby’s lungs and may help baby to get off the ventilator
- Improve blood flow to intestines and rest of body
- Improve heart function
Home Care (“What do I need to do once my child goes home?”)
- Diet: Formula or breast milk appropriate for the baby
- Activity: By the time baby goes home, activity should be normal
- Wound care: Incision on chest can be washed with soap and water.
- Medicines: Nothing particular to this condition
- What to call the doctor for: Redness, warmth, drainage from incision, fever, problems breathing
- Follow-up care: The surgeon usually sees baby two weeks after surgery (if baby is still in hospital, the surgeon will usually see baby while still in hospital)
Long-Term Outcomes (“Are there future conditions to worry about?”)
No significant long-term outcomes except that the titanium clip (if used) will always be visible on chest X-ray (but will not go off in metal detectors or have problems with MRIs).
Author: Grace Mak, MD
Editors: Patricia Lange, MD; Marjorie J. Arca, MD