Patent Ductus Arteriosus

If the ductus arteriosus remains open after birth and

fails to close it is referred to as a patent ductus
arteriosus. The term patent means open.
Complications associated with patent ductus
arteriosus are poor growth and eating, easy tiring,
and a rapid heart rate. It is also common to notice
that the infant is blue in color, especially while
feeding, due to a lack of oxygen.

Patent Ductus Arteriosus

During the first 60 hours of life,
spontaneous closure of the ductus
occurs in 55% of full-term newborn
infants.
By 2-6 months of age, closure occurs
in more than 95% of healthy infants.

Patent Ductus Arteriosus

Persistent patency of the ductus
arteriosus following birth is
inversely related to gestational
age.
This may be due to the smaller
amount of muscular tissue in the
media with lower intrinsic tone,
and lower responsiveness to
oxygen but higher sensitivity to
the vasodilating effects of
prostaglandin E2 and nitric

Patent Ductus Arteriosus

The clinical features depend on the
magnitude of left-to-right shunt
through the PDA and the ability of
the infant to initiate compensatory
mechanisms to handle the extra
volume load.

Patent Ductus Arteriosus

Because many premature infants have
respiratory distress syndrome, the stage
of development of this disease and the
use of surfactant replacement therapy
will determine the pulmonary vascular
resistance and therefore the shunt.
The maturity of the infant and the stage
of myocardial development determine
the ability to handle the shunt.

Patent Ductus Arteriosus

The most reliable non-invasive
diagnostic tool is echocardiography
with Doppler ultrasound.
In most infants, a modified
parasternal short axis view offers the
best window for PDA visualization.
This view offers the best opportunity
to directly measure the PDA.

Treatment of PDA
In the premature infant an important
aspect of PDA management is fluid
intake. Early fluid restriction to allow
for little more than insensible and
sensible losses will significantly
reduce the risks of PDA, necrotizing
enterocolitis, and death at the
expense of postnatal weight loss.

Treatment of PDA
Simple fluid restriction along with
diuretic use is often recommended to
control the symptoms of a PDA.
Furosemide is commonly used.
Although furosemide is a
prostaglandin agonist, it does not
interfere with PDA closure.

Treatment of PDA
The use of oral or, preferably,
intravenous (lyophilized)
indomethacin to constrict the
ductus arteriosus has led to
successful nonsurgical closure in a
large proportion of treated infants;
the effects of indomethacin
apparently are best when it is
administered before 10 days of age
and in less mature infants.