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Patent Ductus Arteriosus : Pediatric Heart Defect

Author:

Arshika Singh is an Child Health Nurse, has completed her masters from CMC, Ludhiana.

Patent Ductus Arteriorus

Patent Ductus Arteriorus

Patent Ductus Arteriosus is an acyanotic heart defect in which, Ductus arteriosus remains functional after birth which is supposed to be closed down once the baby born. It is most commonly found in low birth weight babies and preterm babies.

Fetal Circulation

Fetal Circulation

3 structures are evident in fetus circulation:

  1. Ductus arteriosus : it serves as the shunt between pulmonary artery and aorta
  2. Ductus venosus : it allows the oxygenated blood to bypass the liver.
  3. Foramen Ovale : is a muscular tissue between the two atria's (right and left) which allows blood to cross atria's and bypass pulmonary circulation

Incidence of PDA

PDA incidence is quite evident upto 20 -40% in preterm and low birth weight baby, whereas it holds low incidence i.e 1 to 2 in 2000 live births in term babies.

Patent Ductus Arteriosus occurs twice as in females to that of Males.

Causes of Patent Ductus

The exact cause of PDA is unknown. Genetic mutation may be the reason for this defect.

PDA is commonly found in :

  • Mothers having prenatal history of Rubella infections.
  • Infants with any genetic conditions like Down Syndrome, Cat Cry Syndrome.

Pathophysiology of PDA

Pathophysiology of PDA

Ductus Arteriosus is an normal connection in fetal circulation, whose function is to shunt the oxygenated blood away from lungs ( as it is filled with amniotic fluid.) Soon after birth Ductus arteriosus closes, if it fails to close it forms communication between pulmonary artery and aorta, which causes the mixing of deoxygenated and oxygenated blood to mix.

As the mixing of blood takes place the Partial pressure of oxygen decreases in blood which as to be distributed by aorta in systematic circulation, due to which the child suffers with many unavoidable health issues.

Signs and Symptoms of Patent Ductus Arteriosis

Signs and Symptoms of Patent Ductus Arteriosus

The Heart murmur present is considered the major sign to diagnose Patent Ductus arteriosus. Some infants develop the sign and symptoms of volume overload. The sign and Symptoms include:

  • bounding pulse
  • fast breathing pattern
  • poor feeding
  • failure to weight gain
  • delicate looking
  • tiring on exertion i.e on breastfeeding
  • sweating

Diagnostic Test for PDA

Two major diagnostic tests, which rule out PDA are:

  1. Electrocardiograph: it is an non- invasive procedure which records the electrical activity of the heart.
  2. Echo cardiograph: This test basically gives the following information-
  • size of PDA structure.
  • flow blood velocity through heart.
  • to find out the left heart enlargement.

Treatment of Patent Ductus Arteriosus

Treatment strategies of Patent Ductus Arteriosus

The treatment strategies largely depends on the child's condition and the complications involved, basically two strategies are opted :

  1. Pharmacological Treatment : In case of pre term babies, PDA often closes by itself. In case of term babies, if it small in size it may go unnoticed or may not cause much heart issues and eventually doesn't need any intervention, but in some babies NSAIDs can be used to treat PDA.
  2. Surgical Closure : If pharmacological treatment fails and the child condition worsens, surgical intervention is recommended. The ductus arteriosus is closed surgically either using ligature or clips.
  3. Catheter based procedure : can be used rarely in pre-term babies but can be used in term babies. In this procedure catheter is inserted through groin blood vessel, guided to the ductus, a coil or plug is used to close the patent ductus arteriosus.

After the surgery, risk for infection, congestive cardiac failure are some of the complications which is taken care of.

Home Care of Child with Patent Ductus Arteriosus

Home care of the child with patent ductus arteriosus is very important, as the effectiveness of treatment lies in lifestyle

  1. Preventing Infection : risk of infection like in crowd places, preventing dental caries, frequent chest infection. They are at the risk of developing infective endocarditis.
  2. Play activities : avoid exertional activities, be productive in play activities.

My Personal Experience with Patent Ductus Arteriosus Baby.

A 32 weeks gestational male child chokes on breast feeding ,coughs and refuses to latch on feeding. On examining the baby and on doing the echocardiograph, PDA was diagnosed. Since, the baby was preterm, so no intervention was done, but feeding issue was resolved through Oro - Gastric feeding. Later, after 38 weeks of gestation, Ductus Arteriosus was still found to be patent, so pharmacological treatment was opted. With the introduction of pharmacological treatment, ductus arteriosus closes.
During the period, child was monitored for heart rate, respiratory rate, feeding problems, and majorly infection.

A preterm baby with PDA was in an incubator, to provide isolation from infection, proper temperature maintenance , so any physical draught condition can be avoided.

Secondly, PDA is a defect with good prognosis. Small PDA may go unnoticed also, but large PDA need either pharmacological or Surgical intervention.



Conclusion

Patent ductus arteriosus is an congenital cardiac birth defect which is acyanotic in nature. It discuss about incidence, causes, pathophysiology, signs and symptoms, diagnostic procedures and treatment strategies for child having complications of patent ductus arteriosus.

© 2021 Anu

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