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.
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.
PDA is one of the conditions affecting babies with very low birth weight (VLBW).Why is PDA a concern? Problems are more likely to occur if the 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.
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.
Babies who require surgical ligation usually remain in the NICU during the surgery and post-operative care is provided by the same team of doctors and nurses.
We have a support group (early starter club) for parents of premature babies that comprises doctors, nurses, medical social workers as well as parents of previous premature babies managed in our NICU.
In our VLBW cohort (2015-2019), 78 out of 268 (29%) VLBW babies had a symptomatic PDA. 73% of 78 VLBW babies with symptomatic PDA were successfully treated with medication and the remaining 27% underwent surgical ligation. There were no deaths in babies who had ligation.
Information is correct as of December 2019.