Patent Ductus Arteriosus (Children)

In premature infants, Patent Ductus Arteriosus (PDA) can lead to breathing difficulties, requiring increased respiratory support. A heart murmur is often detectable upon examination. In very premature and small babies, a large PDA can sometimes cause life-threatening pulmonary haemorrhage (bleeding into the lungs).

The PDA is a blood vessel that is present in all babies when they are in the womb, connecting the aorta to the pulmonary artery. In utero, the PDA diverts blood away from the lungs, which are not involved in gas exchange before birth.

After birth, as the lungs expand and begin gas exchange, the PDA usually closes spontaneously. In premature babies, however, this closure might not occur as expected, leading to excessive blood flow to the lungs from the aorta.

PDA is a common issue in  very low birth weight (VLBW) babies. This condition becomes a concern, particularly when the PDA is large, causing excessive pulmonary blood flow and inadequate circulations to other body parts. This can exacerbate respiratory problems, potentially lead to heart failure and impede growth.

PDA in premature babies is typically suspected through clinical examination and confirmed with bedside echocardiography. This imaging test also assesses the size of the PDA.

Treatment options include:

• Fluid restriction
  
• Medication: Indomethacin or similar drugs
• Surgical ligation: In rare cases, where medical treatment fails, the PDA is surgically closed
  

Most PDAs in premature babies respond to medical management. Our Neonatal Intensive Care Unit (NICU) team, comprising experienced doctors and nurses, administers this treatment. If medical therapy fails, cardiothoracic surgeons perform surgical ligation under general anaesthesia.

Babies undergoing surgical ligation continue to receive care in the NICU from the same medical team.

Our ‘early starter club’ support group includes healthcare professionals and parents of former NICU patients, offering support to parents of premature babies.

In our VLBW cohort (2015-2019), 78 out of 268 (29%) VLBW babies had a symptomatic PDA. Of these 78 babies, 73% 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.