PATENT DUCTUS ARTERIOSUS NEWBORNS
Category: Child Health
Abstract : 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
clinica
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.
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