Patent ductus arteriosus (PDA) in the newborn

Q25.0

DESCRIPTION

Patent ductus arteriosus (PDA) is the extra-uterine persistence of the normal fetal vessel that joins the pulmonary artery to the aorta.

DIAGNOSTIC CRITERIA

Clinical

Depending on size of PDA:

  • systolic or continuous murmur at left heart base,
  • hyperactive precordium with easily palpable bounding peripheral pulses.

Investigations

  • Echocardiography should be done to confirm the diagnosis in all symptomatic children with a heart murmur.
  • Observe and follow up all asymptomiatic patients.

Risk factors include:

  • prematurity,
  • pulmonary hypertension,
  • hypoxia,
  • sepsis,
  • fluid overload,
  • lung disease,
  • anaemia, and
  • congenital cardiac abnormalities.

Complications include cardiac failure, systemic hypotension, pulmonary haemorrhage and steal phenomena, such as a decrease in mesenteric blood flow.

GENERAL AND SUPPORTIVE MEASURES

Preterm Infants

  • Identify and treat underlying risk factors.
  • Restrict fluid intake to 80–120 ml/kg/24 hours. Individualise volume to avoid over restriction of fluid and poor weight gain.
  • Maintain haematocrit at ≥ 40% and Hb ≥ 13 g/dL.
  • Monitor cardiac function, renal function and urinary output.
  • Provide adequate nutrition.
  • Nurse in neutral thermal environment.

MEDICINE TREATMENT

In confirmed cases (in consultation with specialist)
Cardiac failure
Diuretics

  • Furosemide, IV/oral, 1 mg/kg/24 hours.

Closure of PDA in preterm infants less than 14 days of age

  • Ibuprofen, oral.
    First dose: 10 mg/kg. After 24 hours follow with 2 doses of 5 mg/kg 24 hours apart.
    Contraindications to ibuprofen therapy:
    • Thrombocytopaenia (< 50 000/mm³).
    • Bleeding disorders.
    • Impaired renal function.
    • Jaundice approaching exchange transfusion levels.

SURGICAL TREATMENT

Consider if medicine treatment is contraindicated or fails.

REFERRAL

  • Patients with complications, e.g. cardiac failure, pulmonary haemorrhage, ventilator dependence.
  • PDA which remained patent despite adequate treatment.
  • Term babies with symptomatic or persistent PDA.
  • PDA in baby unable to take oral ibuprofen.