NICU - Patent Ductus Arteriosis (PDA)

NICU
Neonates, Infant, Newborn, Baby, Preemie
Patent Ductus Arteriosis (PDA)

What is Patent Ductus Arteriosis?
From the National Heart, Lung and Blood Institute [Source]

Patent ductus arteriosus (PDA) is a heart problem that occurs soon after birth in some babies. In PDA, abnormal blood flow occurs between two of the major arteries connected to the heart.

Before birth, the two major arteries—the aorta and the pulmonary (PULL-mun-ary) artery—are connected by a blood vessel called the ductus arteriosus. This vessel is an essential part of fetal blood circulation.

Within minutes or up to a few days after birth, the vessel is supposed to close as part of the normal changes occurring in the baby's circulation.

In some babies, however, the ductus arteriosus remains open (patent). This opening allows oxygen-rich blood from the aorta to mix with oxygen-poor blood from the pulmonary artery. This can put strain on the heart and increase blood pressure in the lung arteries.

Treatment
From the National Heart, Lung and Blood Institute [Source]

Patent ductus arteriosus (PDA) is treated with medicines, catheter-based procedures, and surgery. The goal of treatment is to close the PDA to prevent complications and reverse the effects of increased blood volume.

Small PDAs often close without treatment. For full-term infants, treatment is needed if the child's PDA is large or causing health problems.

For premature infants, treatment is needed if the PDA is causing breathing problems or heart problems.

Talk to your child's doctor about treatment options and your family's preferences on treatment decisions.

Medicines

Your child's doctor may prescribe medicines to help close your child's PDA.

Indomethacin is a medicine that helps close PDAs in premature infants. This medicine works by stimulating the PDA to constrict or tighten, closing the opening. Indomethacin usually doesn't work in full-term infants.

Ibuprofen is a medicine in the same family as indomethacin. It's also frequently used to close PDAs in premature infants.

Catheter-Based Procedures

Catheters are thin, flexible tubes used in a procedure called cardiac catheterization (KATH-e-ter-i-ZA-shun). Catheter-based procedures often are used to close PDAs in infants or children who are large enough to have the procedure.

Your child's doctor may refer to the procedure as "transcatheter device closure." The procedure sometimes is done on small PDAs to prevent the risk of infective endocarditis (IE), an infection of the lining of the heart, valves, or arteries.

During the procedure, your child will be sedated or given medicine so that he or she will sleep and not feel any discomfort. The doctor will place a catheter in a large blood vessel in the upper thigh (groin) and guide it to your child's heart.

A small metal coil or other blocking device is then passed up through the catheter and placed in the PDA to block blood flow through the vessel.

Catheter-based procedures don't require the child's chest to be opened. They also let the child recover quickly.

Closing a PDA using a catheter often is done on an outpatient basis. You'll most likely be able to take your child home the same day the procedure is done.

Complications from catheter-based procedures are rare and short term. They can include bleeding, infection, and movement of the blocking device from where it was placed.

Surgery

Surgery for PDA may be done if:

A premature or full-term infant develops health problems from the PDA and is too small to have a catheter-based procedure
A PDA isn't successfully closed by a catheter-based procedure
Surgery is planned for treatment of related congenital heart defects

Often, surgery isn't done until after 6 months of age in infants who don't have health problems from their PDAs. Doctors sometime perform surgery on small PDAs to prevent the risk of IE.

For the surgery, your child will be given medicine so that he or she will sleep and not feel any discomfort. The surgeon will make a small cut between your child's ribs to reach the PDA. He or she will then close the PDA with stitches or clips.

Complications from surgery are rare and usually short term. They can include hoarseness, a paralyzed diaphragm (the muscle below the lungs), infection, bleeding, or fluid buildup around the lungs.