Patent Ductus Arteriosus (PDA) in the Newborn
Description Diagnostic criteria General and supportive measures Medicine treatment Surgical treatment Referral ICD-10 code: Q25.0 DESCRIPTION Patent ductus arteriosus (PDA) is the extra-uterine persistence of the normal foetal vessel that joins the pulmonary artery to the aorta. DIAGNOSTIC CRITERIA Clinical Depending on size of PDA: A systolic or continuous murmur at the upper left sternal
Description
Diagnostic criteria
General and supportive measures
Medicine treatment
Surgical treatment
Referral
ICD-10 code: Q25.0
DESCRIPTION
Patent ductus arteriosus (PDA) is the extra-uterine persistence of the normal foetal vessel that joins the pulmonary artery to the aorta.
DIAGNOSTIC CRITERIA
Clinical
Depending on size of PDA:
- A systolic or continuous murmur at the upper left sternal border.
- Hyperactive precordium with easily palpable bounding peripheral pulses.
Investigations
- Echocardiography should be done to confirm the diagnosis in all symptomatic children with a heart murmur.
- Observe and follow-up all asymptomatic patients.
Risk factors include:
- prematurity,
- pulmonary hypertension,
- hypoxia,
- sepsis,
- fluid overload,
- lung disease,
- anaemia, and
- congenital cardiac abnormalities.
Complications include cardiac failure, systemic hypotension, pulmonary haemorrhage and steal phenomena, such as a decrease in mesenteric blood flow.
GENERAL AND SUPPORTIVE MEASURES
Preterm Infants
- Identify and treat underlying risk factors.
- Restrict fluid intake to 80% of maintenance. Individualise volume to avoid over restriction of fluid and poor weight gain.
- Maintain haematocrit at ≥ 40% and Hb ≥ 13 g/dL.
- Monitor cardiac function, renal function and urinary output.
- Provide adequate nutrition.
- Nurse in a neutral thermal environment.
MEDICINE TREATMENT
In confirmed cases (in consultation with specialist):
Cardiac failure
Diuretics
- Furosemide, IV/oral, 1 mg/kg/24 hours.
Closure of PDA in preterm infants less than 14 days of age
- Ibuprofen, oral.
First dose: 10 mg/kg. After 24 hours, follow with 2 doses of 5 mg/kg 24 hours apart.
Contraindications to ibuprofen therapy:- Thrombocytopenia (< 50 000/mm3 ).
- Bleeding disorders.
- Impaired renal function.
- Jaundice approaching exchange transfusion levels.
- Duct-dependant cyanotic heart disease
OR
- Paracetamol, oral.
- Can be used when there are contraindications to Ibuprofen.
- Dosage: 15 mg/kg every 6 hours for 5 days.
- Contraindications to paracetamol: Liver failure.
SURGICAL TREATMENT
Consider if medicine treatment is contraindicated or fails.
REFERRAL
- Patients with complications, e.g. cardiac failure, pulmonary haemorrhage, ventilator dependence.
- PDA which remained patent despite adequate treatment.
- Term babies with symptomatic or persistent PDA.
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 19: Prematurity And Neonatal Conditions, 19.3 Prematurity/Preterm Neonate, 19.3.2 Patent Ductus Arteriosus (PDA) In The Newborn