PATENT DUCTUS ARTERIOSUS NEWBORNS

patent ductus arteriosus
In the fetus, the ductus arteriosus is a conduit between the left pulmonary artery and the aorta that results in shunting of blood past the lungs. In full-term newborns, the PDA typically closes within 48 hours of birth because of oxygen-induced prostaglandin production, which constricts the ductus.

However, as many as 80% of ELBW infants have a clinically significant PDA, resulting in a left-to-right shunt that causes a variety of symptoms, including a loud systolic murmur, widened pulse pressures, bounding pulses, hyperactive precordium, increased effort to breathe, and, because of a net decrease in systemic cardiac output due to left-to-right shunting, decreased urine output, feeding intolerance, and hypotension.

Diagnosis typically is confirmed using echocardiography, and treatment includes decrease of fluid intake, indomethacin administration, and surgical ligation, if necessary.

Indomethacin is used prophylactically at some institutions and is administered in the first 24 hours of life to close a PDA in anticipation of the deleterious effects of a continued PDA in an ELBW infant. Some evidence suggests that prophylactic use of indomethacin has led to decreased symptomatic PDAs and PDA ligations in ELBW infants.

Concerns regarding indomethacin and its effects on cerebral and renal blood flow have led to the investigation of the role of intravenous ibuprofen as an agent to close a PDA in preterm infants.