Treatment of patent ductus arteriosus (PDA) in premature babiesTTreatment of patent ductus arteriosus (PDA) in premature babiesTreatment of patent ductus arteriosus (PDA) in premature babiesEnglishNeonatology;CardiologyPremature;Newborn (0-28 days);Baby (1-12 months)HeartCardiovascular systemDrug treatment;Non-drug treatmentPrenatal Adult (19+)NA2009-10-31T04:00:00ZPatrick McNamara, MB, BCh, BAO, FRCPCAndrew James, MBChB, FRACP, FRCPC12.000000000000032.00000000000001069.00000000000Flat ContentHealth A-Z<p>Learn about the treatment of a patent ductus arteriosus (PDA) in premature babies. The PDA closes the blood vessel, regulating blood flow.</p><p>In some premature babies, the ductus arteriosis may not close completely or sufficiently, leaving a small opening. Treatment for a patent ductus arteriosis (PDA), depends on the size of the opening and the effect the opening is having on the body.</p><h2>Key points</h2> <ul><li>A baby who has PDA may have an enlarged heart, increase in carbon dioxide levels, and increased blood pressure in the lungs and weakened left heart ventricle.</li> <li>There are three ways in which doctors can close a PDA, depending on the size of the opening, and the effect it is having on the baby's body.</li> <li>The three treatments are management and spontaneous closure, drug therapy, and surgery.</li></ul>
Traitement de la persistance du canal artériel (PCA) chez les bébés prématurésTTraitement de la persistance du canal artériel (PCA) chez les bébés prématurésTreatment of patent ductus arteriosus (PDA) in premature babiesFrenchNeonatology;CardiologyPremature;Newborn (0-28 days);Baby (1-12 months)HeartCardiovascular systemDrug treatment;Non-drug treatmentPrenatal Adult (19+)NA2009-10-31T04:00:00ZPatrick McNamara, MB, BCh, BAO, FRCPCAndrew James, MBChB, FRACP, FRCPC12.000000000000032.00000000000001069.00000000000Flat ContentHealth A-Z<p>Renseignez-vous sur le traitement de la persistance du canal artériel (PCA) chez les bébés prématurés. La PCA ferme les vaisseaux sanguins qui régulent le débit sanguin.</p><p>Dans l’utérus, le fœtus reçoit de l’oxygène de la mère. Comme il n’est pas nécessaire que le sang passe par les poumons du fœtus, le sang est dévié des poumons à l’aide d’une artère appelée canal artériel. </p> <p>Une fois que le bébé est né, son premier souffle amène des changements qui ont aussi des conséquences sur la fonction du cœur. Soudainement emplis d’air, les poumons se dilatent, les vaisseaux sanguins à l’intérieur des poumons se détendent et le débit sanguin augmente, permettant ainsi un meilleur échange gazeux. L’augmentation soudaine du niveau d’oxygène dans le sang contribue à la fermeture du canal artériel. De plus, comme le placenta ne fait plus partie de la circulation, la concentration des substances appelées prostaglandines dans le sang est réduite; elle favorise également la fermeture du canal artériel. Dans des circonstances normales, le canal artériel se ferme complètement et est remplacé par un tissu cicatriciel en quelques semaines, et ne se rouvrira jamais. </p> <p>Chez certains bébés prématurés, ce processus de fermeture ne se fait pas du tout ou pas suffisamment, laissant une petite ouverture, ce qui a des conséquences sur le débit sanguin normal. C’est ce qu’on appelle la persistance du canal artériel (PCA). Dans ce contexte, « persistance » signifie « demeure ouvert ». </p><h2>À retenir</h2> <ul><li>Un bébé atteint de persistance du canal artériel peut avoir une hypertrophie cardiaque, une augmentation du niveau de dioxyde de carbone, une augmentation de la pression artérielle dans les poumons et une faiblesse du ventricule gauche du cœur.</li> <li>Il existe trois façons de fermer la persistance du canal artériel, selon la taille de l’ouverture et son effet sur le reste de l’organisme du bébé.</li> <li>Les trois traitements sont le soulagement et la fermeture spontanée, la pharmacothérapie et l’intervention chirurgicale.</li></ul>

 

 

Treatment of patent ductus arteriosus (PDA) in premature babies1839.00000000000Treatment of patent ductus arteriosus (PDA) in premature babiesTreatment of patent ductus arteriosus (PDA) in premature babiesTEnglishNeonatology;CardiologyPremature;Newborn (0-28 days);Baby (1-12 months)HeartCardiovascular systemDrug treatment;Non-drug treatmentPrenatal Adult (19+)NA2009-10-31T04:00:00ZPatrick McNamara, MB, BCh, BAO, FRCPCAndrew James, MBChB, FRACP, FRCPC12.000000000000032.00000000000001069.00000000000Flat ContentHealth A-Z<p>Learn about the treatment of a patent ductus arteriosus (PDA) in premature babies. The PDA closes the blood vessel, regulating blood flow.</p><p>In some premature babies, the ductus arteriosis may not close completely or sufficiently, leaving a small opening. Treatment for a patent ductus arteriosis (PDA), depends on the size of the opening and the effect the opening is having on the body.</p><h2>Key points</h2> <ul><li>A baby who has PDA may have an enlarged heart, increase in carbon dioxide levels, and increased blood pressure in the lungs and weakened left heart ventricle.</li> <li>There are three ways in which doctors can close a PDA, depending on the size of the opening, and the effect it is having on the baby's body.</li> <li>The three treatments are management and spontaneous closure, drug therapy, and surgery.</li></ul><p>In the womb, the fetus gets oxygen from the mother. As there is no need for blood to pass through the lungs of the fetus, the blood is diverted away from the lungs by an artery called the ductus arteriosus. </p><p>Once a baby is born, their first breath initiates changes which also influence the function of the heart. Suddenly filling with air, the lungs expand, the blood vessels within the lungs relax, and blood flow increases, allowing for better gas exchange. The sudden increase in blood oxygen levels contributes towards closure of the ductus arteriosus. In addition, as the placenta is no longer a part of the circulation, the blood level of substances called prostaglandins is reduced; this also helps the ductus arteriosus to close. Under normal circumstances, the ductus arteriosus is completely sealed and replaced with scar tissue in a few weeks, never to open again. </p><p>With some premature babies, this process of closure either does not happen at all or does not happen sufficiently, leaving a small opening. As a result, normal blood flow is affected. This condition is called patent ductus arteriosus (PDA). “Patent,” in this context, means “open.” </p><h2>Severity and complications of a PDA</h2><p>Because a PDA diverts blood away from the lungs and back to the heart, some blood does not get oxygenated, creating a lack of oxygen delivery to the rest of the body and a corresponding increase in carbon dioxide levels. In addition, the amount of blood supplying other vital organs may also be reduced. The heart may enlarge in order to increase blood flow. A severe PDA may increase blood pressure in the lungs and cause weakness in the left ventricle of the heart. This in turn may create pulmonary edema, which is fluid build-up in the lungs, which will make breathing very difficult. </p><h2>Closing a PDA</h2><p>The goal of treating a PDA is to close the blood vessel, allowing a normal supply of blood to the body. There are three ways in which doctors can get the PDA to close. The choice of which method to use depends on the size of the opening and the effect that the opening is having on the body. If the opening is small and the consequences of the abnormal blood flow are minimal, management of the symptoms and time may be all that is necessary; the opening may close on its own. If the opening is large and abnormal blood flow is creating more significant problems, more invasive methods, including medication and surgery, may be used. </p><h3>PDA management and spontaneous closure</h3><p>If a PDA is small and not interfering with blood flow to any great extent, waiting for spontaneous closure may be the strategy. The vast majority of babies born with a PDA fit into this asymptomatic category. Under normal circumstances, a PDA will close within a few days. It may be that the premature baby needs extra time for the PDA to close on its own. Spontaneous closure, as it is called, is common, especially in babies who are only mildly premature. </p><p>The staff in the Neonatal Intensive Care Unit (NICU) will carefully control fluids to prevent excessive blood flow to the lungs while ensuring enough blood flow to the vital organs. An excessive volume of fluid may translate into too much blood flow, discouraging the PDA from closing. </p><h3>Drug therapy for PDA</h3><p>If the PDA does not close on its own or it is large enough to be causing circulation complications, drug therapy may be used to encourage a persistent PDA to close. While in the womb, the ductus arteriosus is meant to stay open. The placenta is a rich source of a substance called prostaglandin E <sub>2</sub>, which is crucial in preventing the artery from closing. If a PDA remains open after birth, indomethacin may be prescribed. Indomethacin inhibits the action of prostaglandin E <sub>2</sub>. The administration of this medication is often enough to close the PDA. Indomethacin is especially effective if it is taken within the first 10 to 14 days after birth. </p><p>Indomethacin can have side effects, including bleeding, infection, and other longer-term complications. If indomethacin is administered too rapidly, it may cause a drop in blood flow to the kidneys and bowel. Slow administration of the medication will avoid these complications. Indomethacin can sometimes cause the platelets of the blood to become less sticky, increasing the risk of bleeding. For premature babies with a normal platelet count, this is not usually a problem; however, if a baby has a low platelet count, indomethacin may not be given. </p><p>There is some evidence that <a href="/Article?contentid=153&language=English">ibuprofen​</a> administered intravenously can also have the same effect as indomethacin, with similar efficacy but fewer side effects. This treatment is still under study and is not yet widely available in North America . </p><h3>Surgery for PDA</h3><p>If drug therapy fails or is not an option due to other complications that the premature baby has, surgery may be performed. Surgical ligation, as the procedure is called, is normally considered a low-risk procedure and is successful in an overwhelming amount of cases, even for very premature babies. </p><p>The surgery may be performed in the traditional manner using open heart surgery, or with a very thin tube called a catheter. The method used to close the ductus arteriosus varies depending on the size of the opening. Sometimes sewing up the hole is enough, while at other times a small patch may be sewn over the opening from the inside of the heart. </p><p>Although the success rate for the surgery is very good, if there are other deformities in the heart, the risks increase. Sometimes the baby becomes unstable in the immediate 24 to 48 hours after surgical intervention. Specifically, some babies may have an increased need for ventilator support or treatment for heart failure and low blood pressure. These effects probably relate to the immaturity of the heart muscle and in most cases will not last. Other complications from the surgery, though rare, include bleeding, blood vessel or nerve damage, and infection. </p><p>More information:</p><ul><li> <a href="/Article?contentid=1617&language=English">Patent ductus arteriosus (PDA) in premature babies</a></li><li> <a href="/Article?contentid=1802&language=English">Diagnosis of patent ductus arteriosus (PDA) in premature babies</a></li></ul>Treatment of patent ductus arteriosus (PDA) in premature babies

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