Patent ductus arteriosus (PDA) is an opening between two major blood vessels of the heart after birth. The opening is normal before birth and is known as ductus arteriosus, which plays a vital role in fetal circulation. However, if the opening persists after birth, it could cause health problems.
Doctors may recommend monitoring, medications, surgery, or catheterization to treat PDA according to the size of the defect, symptoms, and the baby’s term.
Read this post to know more about the causes, signs, complications, diagnosis, treatment, and prevention of patent ductus arteriosus in babies.
Causes Of PDA In Babies
The exact cause of patent ductus arteriosus is not known. Congenital heart defects can be due to fetal heart development issues, which could be influenced by environmental or genetic factors.
The following risk factors may increase the chance of having patent ductus arteriosus (1).
- Premature birth
- Positive family history of heart defects
- Genetic conditions, such as Down syndrome
- Gender of the baby (female babies may have a higher risk of PDA than males)
- German measles (rubella) infection during pregnancy may lead to PDA since the virus moves through the placenta and damages blood vessels and fetal organs, such as the heart.
- Babies born at places on a high altitude may have an increased risk of PDA than babies born at places on a low altitude.
Some babies may not develop PDA despite the presence of risk factors, while some babies may have PDA without any discernible causes and risk factors.
Signs And Symptoms Of PDA
Symptoms of patent ductus arteriosus may vary depending on the baby’s term and the size of the defect. A small PDA may go undetected until adulthood since it may not cause severe symptoms. In contrast, a large-sized defect shows signs and symptoms soon after birth.
Common signs and symptoms seen in infants with a large PDA may include (2):
- Slow growth due to poor eating
- Sweating while eating or crying
- Getting tired easily
- Rapid heart rate
- Fast breathing or breathlessness
You may consult a pediatrician for an exact diagnosis since these symptoms and signs can also be seen in other conditions.
Possible Complications Of PDA
A small-sized patent ductus arteriosus may not result in complications. A large-sized PDA, on the other hand, may cause excessive blood to circulate in the baby’s heart and lungs, leading to increased pulmonary hypertension. It may eventually result in heart failure.
Untreated large PDA may lead to the following complications in some babies (3).
- Heart failure may happen when the heart becomes enlarged and weakened due to patent ductus arteriosus. It is a chronic condition where the heart fails to pump enough blood.
- Pulmonary hypertension is high blood pressure in the lungs that can result in permanent lung damage. Large PDA may cause Eisenmenger syndrome that leads to irreversible pulmonary hypertension.
- Endocarditis is the inflammation of the inner lining of the heart. The risk of infective endocarditis is high in cases of structural heart defects.
Complications are more severe and cause permanent damages than PDA itself. Early interventions and medications could help resolve PDA before it causes adverse effects.
When To See A Doctor?
You may consider visiting a pediatrician if your baby has any of the following signs and symptoms.
- Getting tired easily when eating or playing
- Not gaining weight
- Breathlessness while eating or crying
- Rapid breathing or shortness of breath
You may explain your baby’s symptoms and signs to a pediatrician for an early appointment. Waiting for the regular checkup may not be ideal if your baby has symptoms of PDA.
Diagnosis Of PDA
An asymptomatic PDA case can be discovered during regular checkups since doctors can hear heart murmurs through the stethoscope. If the physical examination suggests a heart defect, doctors may order the following tests to confirm the diagnosis (4).
- Echocardiograms help evaluate the structure and function of the heart. Heart valve pathologies, enlarged heart chambers, and other heart defects can be assessed through echocardiography.
- Electrocardiogram (ECG) could help determine the rhythm of the heart and any conduction abnormalities.
- Chest X-ray could help visualize the chest cavity and identify any other conditions.
- Cardiac catheterization helps diagnose and also treat PDA.
These tests can be performed to confirm or exclude the diagnosis of various heart defects. Cardiac catheterization also provides treatment along with the diagnosis. This diagnosis method is chosen when the pediatric cardiac surgeon plans to diagnose and close the PDA simultaneously.
Treatment For PDA In Babies
Treatment options may vary depending on the term of the baby. The doctor may consider the following treatments for PDA in babies (5).
- Watchful waiting is recommended for premature babies since the PDA may close on its own. Term babies and children with small defects may also continuously be monitored without any intervention if there is no cause for concern.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and indomethacin, are prescribed for preemies to close PDA. NSAIDs block the chemicals in the body that keep PDA open in premature babies. These medicines may not work for other age groups and term babies.
- Surgical closure is recommended if medication fails to close PDA and severe symptoms or complications are present. The surgical incision is made between ribs to access the heart and may require several days of hospitalization.
- Catheter procedures are preferred for term babies and children. Preemies are too small to undergo cardiac catheterization procedures.
Taking preventive antibiotics for six months is recommended after the surgery to prevent infectious endocarditis. Periodic follow-up care is required for babies with PDA to monitor heart functions.
Prevention Of PDA
There is no exact way to prevent PDA in babies. Maternal health and lifestyle may play a role in the development of healthy hearts in babies. The following measures may help reduce the risk of heart defects.
- Seek early prenatal care
- Consider preconception care, such as reducing stress and quitting smoking
- Follow a healthy diet containing iron, folic acid, vitamins, and minerals
- Do regular physical activity
- Avoid the use of tobacco, alcohol, and narcotics before and during pregnancy
- Get vaccinated to avoid infections, such as rubella
- Keep diabetes and other medical conditions under control
- Always take pregnancy-safe medications as per the doctor’s prescription
If you or your spouse has a family history of genetic conditions and heart defects, or you already have a child with any of these conditions, seek genetic counseling before planning a pregnancy.
There is no precise cause of PDA in babies. Babies with the condition or those who underwent corrective surgeries require regular monitoring of their cardiac structure and function. You may plan your baby’s exercise and play as per recommendations since vigorous activity may not be ideal for all. You may also discuss with your baby’s doctor for individual guidance for long-term care of your child.
2. Patent Ductus Arteriosus; MedlinePlus; US National Library Of Medicine
3. Patent Ductus Arteriosus; St. Clair Hospital
4. Patent Ductus Arteriosus; University Of California San Francisco
5. Patent Ductus Arteriosus; Lucile Packard Children’s Hospital Stanford