Patent Ductus Arteriosus

 

Reviewed by David Knight
September
2007
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Incidence Diagnosis Investigations
Management References Other Related Documents

Incidence

Diagnosis

Usually diagnosed late. Most babies treated before this stage.

Investigations

Echocardiogram

Chest X-ray

  • To look at heart size and lung fields.

ECG

  • The ECG is usually normal.
  • It is rarely done in preterm infants.

Management

Indications for treatment

  1. Significant shunt in a small baby with ongoing lung disease.
  2. Closure of the ductus is aimed mainly at improving lung function.

<28 weeks or <1000gms, and on IPPV or CPAP

  • Echocardiogram at 3 days.
  • Significant PDA: Consider indomethacin.

Other babies on IPPV

  • Investigate if clinical suspicion.

Indomethacin

  • See drug protocol.
  • Monitor creatinine, electrolytes, urine output & platelets before and at least daily initially.  If these parameters remain normal, then they do not need to be routinely checked after the 3rd dose.
  • Review baby and results before each dose.
  • Contraindications:
            Thrombocytopenia
            NEC
            Bleeding diathesis
            Poor renal function
            Pulmonary haemorrhage (note: may occur because there is a PDA)

Fluid restriction

  • While on indomethacin, reduce by 20-40ml/kg/day.
  • There is no evidence that fluid restriction per se results in closure of the duct but there are studies suggesting that early, liberal fluid intakes are associated with a higher incidence of PDA.

Surgery

  • If PDA is still clinically significant after indomethacin, or if indomethacin is contraindicated.
  • Surgery will usually be performed on NICU.
  • Note that a increase in respiratory support is often required immediately after surgery.
  • Referral Process

Usual Follow-Up

 

References

1

Knight DB. The treatment of patent ductus arteriosus in preterm infants. A review and overview of randomized trials. Seminars in Neonatology. 2001; 6: 63-73.
2 Cooke L, Steer P, Woodgate P. Indomethacin for asymptomatic patent ductus arteriosus in preterm infants. Cochrane Database of Systematic Reviews 2003, Issue 1.
3 Herrera C, Holberton J, Davis P. Prolonged versus short course of indomethacin for the treatment of patent ductus arteriosus in preterm infants. Cochrane Database of Systematic Reviews 2001, Issue 4.
4 Brooks JM, Travadi JN et al. Is surgical ligation of patent ductus Arteriosus necessary? The Western Australian experience of conservative management. Arch Dis Childh. 2005; 90: F235-F239.
5 Evans N. Current controversies in the diagnosis and treatment of patent ductus arteriosus in preterm infants. Advances in Neonatal Care. 2003; 3: 168-177.