Preemie Resource Blog: PDA-Patent Ductus Arteriosus

Picture from

http://www.nhlbi.nih.gov/health/health-topics/topics/pda/

A Patent Ductus Arteriosus or other wise known as a PDA is a blood vessel that is present in all babies while still in the womb that does not close within the first few hours of life. Ductus arteriosus is a blood vessel that is open while the baby is in the womb, that allows blood to bypass the lungs and allows blood to flow from the pulmonary artery to the aorta. When the baby is born, and the umbilical cord is cut, the baby takes a few large breaths, which cause the lungs to supply the oxygen. The lungs expand, the blood vessels relax and receive more blood flow and the ductus arteriosus usually closes on its own. When the ductus arteriosus does not close on its own it is known as Patent (meaning open) Ductus Arteriosus or PDA. When the PDA does not close it allows oxygen-rich blood from the aorta to mix with oxygen-poor blood from the pulmonary artery. This can strain both the heart and the lungs.

On average PDA is a fairly common congenital heart defect that is diagnosed in the United States. Although the condition can happen in full term babies, its more common in premature infants. It is also twice as common in girls as it is in boys.

Here are some signs that a baby may have a PDA:

Fast Breathing
Working Hard to breathe
Shortness of breathe
Premature babies may need to be put on a ventilator, CPAP machine or nasal cannula due to a PDA
Poor feeding
Poor weight gain
Tiring and wearing out easily

How a PDA can be diagnosed:

Typically a Doctor or nurse can hear a heart murmur that is the result of a baby's PDA. A heart murmur is an extra or unusual sound heard with the heartbeat. There can be several reasons and many causes for a baby or child to have a heart murmur that does not mean they have a PDA.

After a Doctor or nurse suspects a PDA they will then order a Echocardiography (heart echo) or an Electrocardiogram (EKG) to take a look at the baby's heart. The Echo is an ultra sound that can detect the size of the PDA and how the heart is responding to it. The Echo can also tell how the treatment is working. During an EKG the will place electrodes on the baby's chest (arms or legs) to measure heart activity. The EKG traces the activity of the heart onto paper for the doctor to see the rhythm, speed of the heart beat and whether the heart is enlarged.

Treatment for a PDA:

For a full term newborn with a PDA that is showing no signs or symptoms the Doctors will usually try and give it time to close on its own and monitor the PDA with doctor visits. However if a PDA is still present after the newborn stage, it generally will never close on its own.

For a premature baby a PDA can go two different routes, it can either be causing one or several of the symptoms we talked about earlier which would mean the baby would need surgery to close the PDA immediately. If the baby is showing minimal to no regression signs from the PDA then the doctors will take a wait and watch approach, where they will monitor the baby's symptoms and PDA very closely while still in the NICU. A PDA if given time, will usually close on its own in a premature baby but there are some instances where a baby will be discharged from the NICU with a PDA and have to follow up with their pediatrician as well as a pediatric cardiologist to monitor the PDA. In most cases if it does not close between 6 and 12 months then they will either do surgery or a procedure to close it.

The reason why they can not let a PDA go, usually past the age of 1, without it closing is because it puts a child at large risks for contracting an infection called infective endocarditis (IE) which is an infection of the inner lining of the heart chambers and valves.

3 ways to close a PDA:

Sometimes, although it is happening less and less a doctor will treat the PDA with medicine in hopes that it will close sooner without surgery. Doctors will often use Ibuprofen or Indomethacin to treat premature babies to help close the PDA. However those medicines are showing to have many side effects that can effect the kidneys, so Doctor's have started to use this approach less and less. Also these medicines have to be administered within the first 7 days of life for them to be effective.
If a premature baby is having distress with their lungs or heart due to the PDA then a doctor will have to perform a PDA ligation surgery. During a Ligation surgery the baby is put completely under and intubated. During the surgery a small incision between the ribs and the ductus arteriosus is tied and cut. This surgery can be preformed at any age.
Lastly is the Cardiac Catheterization Procedure. If a full term newborn makes it to 6 to 12 months with its PDA then usually a doctor will opt to perform a Cardiac cathererzation procedure. The baby or child is sedated and catheters are placed into the blood vessels in the groin and fed up to the heart where they take pictures of the ductus arteriosus with dye. They will then use either a coil or flexible device within the ductus to "plug" it.

My daughter Nora was born at 25weeks 5 days and she was diagnosed at 1 week old with a PDA. We were lucky due to the fact that Nora has had minimal complications so far with her PDA. There were a few times in the NICU when Nora had to go up on her oxygen because they thought that her PDA was causing her heart to shunt ( oxygen-rich blood from the aorta to mix with oxygen-poor blood from the pulmonary artery). Nora also had a hard time coming off her oxygen, but she was finally oxygen free 2 days before discharge! However she still needed the oxygen for feeds so we were sent home with oxygen. Doctors said this was most likely because of her Chronic lung disease but also because of her PDA still being open.

When Nora was first diagnosed with her PDA it was considered small and minimal and when she contracted an infection a few weeks later, her PDA went from small to large. The Doctors have kept a close eye on it, but she was discharged from the NICU at 39weeks 3 days and her PDA had not closed. It is now considered small-moderate in size. Nora also has high blood pressure, which her Pediatrician wants to make sure is not being caused by her PDA so we have been referred to a Cardiologist. Nora is now almost 6 months actual and 2.5months adjusted and we will be seeing a Pediatric Cardiologist in two weeks, 6 days after her 6month birthday. Judging from everything I have read and heard it sounds like Nora's PDA is past the point where it will most likely close on its own. Her Cardiologist could still give it a bit more time, but we will have to wait and see what he decides. I am still not sure because of her being a preemie and still being so little, whether she will have the ligation surgery or she will have the catheterization procedure. Although a PDA can be very serious, it is also very common in premature babies and usually has no long term effects if treated appropriately.

To read more about Nora's story or to follow her PDA outcome you can go to my blog at:

http://purtylittlefowler.blogspot.com/

In researching for this post I have used the following articles:

http://www.nhlbi.nih.gov/health/health-topics/topics/pda/

http://www.cincinnatichildrens.org/health/p/pda/

PDA-Patent Ductus Arteriosus

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PDA-Patent Ductus Arteriosus

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