Signs & Symptoms
In premature babies, Patent Ductus Arteriosus (PDA) can cause breathing difficulties that may necessitate increased respiratory support. A murmur may be heard on examination of the heart. In very premature and small babies, a large PDA may occasionally result in bleeding into the lungs (pulmonary hemorrhage) which can be life threatening.
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What causes it
Patent Ductus Arteriosus (PDA) is a blood vessel that is present in all babies when they are in the womb. This blood vessel connects the aorta (a large artery that supplies blood from the heart to various parts of the body) and the pulmonary artery (a large artery that supplies blood to the lungs). When the baby is in the womb, PDA normally diverts blood from the pulmonary artery to the aorta as the lungs do not take part in gas exchange.
After birth, when the lungs expand, all the blood in the pulmonary artery flows to the lungs and the PDA which is not needed anymore closes spontaneously in the majority of babies.
However when a baby is born prematurely, this blood vessel may not close as expected, resulting in excessive blood flow to the lungs from the aorta
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About the condition
Patent Ductus Arteriosus (PDA) is one of the condition which babies with very low birth weight (<1500g) may suffer from.
Why is Patent Ductus Arteriosus (PDA) a concern? Problems are more likely to occur if the Patent Ductus Arteriosus (PDA) is large. The shunting causes too much blood to flow to the lungs and not enough to other parts of the body. Large PDA in premature babies can complicate respiratory problems, making gas exchange in the lungs more difficult. It may also result in heart failure and can cause poor growth.
How common is Patent Ductus Arteriosus (PDA)? At our institution over an 8 year period between 2001 to 2008, 143 out of 339 (40%) VLBW (very low birth weight, <1500 grams at birth) babies developed a PDA that required some form of treatment.
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Diagnosis and Treatment Options
Patent Ductus Arteriosus (PDA) is usually suspected in a premature baby by clinical examination. An echocardiography of the heart (ultrasound scanning) done at the bedside can confirm the diagnosis. This ultrasound examination can also determine the size of the PDA.
Treatment options include fluid restriction, medical treatment with drugs such as indomethacin and occasionally, surgical ligation (where the PDA is ligated in a surgical operation).
In the majority of instances medical management is effective in closing a PDA. Our team of doctors and nurses in the Neonatal Intensive Care Unit (NICU) is experienced in diagnosing and treating this condition. In the rare occasion of failure with medical therapy, surgical ligation is done by the cardiothoracic surgeons under general anaesthesia.
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Post-operative Care
Babies who require surgical ligation usually remain in the Neonatal Intensive Care Unit (NICU) during the surgery and post-operative care is provided by the same team of doctors and nurses.
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Support Group
We have a support group (early starter club) for parents of premature babies that comprises of doctors, nurses, medical social workers as well parents of previous premature babies managed in our Neonatal Intensive Care Unit (NICU).
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Clinical Outcomes
In our institution, 81% of 143 VLBW babies with symptomatic Patent Ductus Arteriosus (PDA) were successfully treated with medication and the remaining 19% underwent surgical ligation. There were no deaths in babies who had ligation. Rare complications of surgery include vocal cord palsy in a few babies and chylothorax in one infant.
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