Patent ductus arteriosus (PDA) is a condition in newborns of a persistent opening, called the ductus arteriosus, which in otherwise normal circumstances remains open before birth and closes shortly after birth. The opening is part of a fetus’s circulatory system that gets closed at birth.
The symptoms vary with the extent of the condition and also, the status of the delivery - if the baby is premature or full-term. However, a small PDA may not throw up any signs and symptoms, and require no treatment well until adulthood. A big one if left unattended will weaken the heart muscles and cause heart failure and other complications by allowing poorly oxygenated blood soon after birth. Common symptoms include
- A faint murmur in the heart on a routine examination by a stethoscope
- Poor eating, poor growth and no weight gain
- Sweating during crying or eating
- Constant fast breathing or breathlessness during eating or crying
- Easily tired when eating or playing
- Rapid heart beat
The most common risk factors are
- Premature birth - this condition is more common in premature babies than full term ones.
- Family history and genes - A family history of heart ailments and related genetic conditions like Down’s syndrome.
- Rubella (German measles) during pregnancy - The rubella virus during pregnancy crosses the placenta and spreads through the baby's circulatory system, damaging blood vessels and organs, including the heart.
- High altitude risk- Babies born in high altitudes, above 10,000 feet (3,048 meters) are prone to PDA than babies born at lower altitudes.
The diagnosis is very simple. The doctor will run the following tests on the baby -
- Echocardiogram - to check the heart and its valves and chambers for any heart defects and see if the heart is pumping well.
- Chest X-ray - to check the condition of the baby’s heart and lungs to rule out other conditions.
- Electrocardiogram (ECG) - the electrical activity of the heart helps the doctor diagnose heart defects or rhythm problems.
- Cardiac catheterization - to rule out other congenital heart defects found during an echocardiogram or if a catheter procedure is being considered to treat a PDA.
Treatment entails the following -
- Constant Monitoring - Usually, a PDA in a premature baby closes on its own. And for those full-term babies, children and adults with small PDAs with no other health problems, monitoring is all that's needed.
- Medications - Nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed to close a PDA which block the hormone like chemicals in the body that keep the PDA open. However, NSAIDs don’t work in full-term babies, children or adults with PDA.
- Open-Heart Surgery - when medications fail and the condition deteriorates causing complications, open-heart surgery is recommended. Possible risks include hoarseness, bleeding, infection and a paralyzed diaphragm.
- Catheter Procedures - This procedure is not recommended for premature babies. The doctor will recommend waiting until the baby is older for a catheter procedure to correct the PDA.