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If the ductus arteriosus remains open after birth and

fails to close it is referred to as a patent ductus

arteriosus. The term patent means open.

Complications associated with patent ductus

arteriosus are poor growth and eating, easy tiring,and a rapid heart rate. It is also common to notice

that the infant is blue in color, especially while

feeding, due to a lack of oxygen.

Patent Ductus Arteriosus

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Patent Ductus Arteriosus

During the frst 60 hours o lie,spontaneous closure o the ductusoccurs in 55% o ull-term newborninants.

By -6 months o age, closure occursin more than !5% o healthy inants.

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Patent Ductus Arteriosus

"ersistent patency o the ductusarteriosus ollowing birth isinversely relatedto gestational

age. #his may be due to the smaller

amount of muscular tissue in the

mediawith lower intrinsic tone,and lower responsiveness tooxygenbut higher sensitivity tothe vasodilating eects of

prostaglandin E2 and nitric

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Patent Ductus Arteriosus

#he clinical eatures depend on themagnitude o let-to-right shuntthrough the "D$ and the ability o

the inant to initiate compensatorymechanisms to handle the etra&olume load.

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Patent Ductus Arteriosus

Because many premature inants ha&erespiratory distress syndrome, the stageo de&elopment o this disease and the

use o suractant replacement therapywill determine the pulmonary &ascularresistance and thereore the shunt.

#he maturity o the inant and the stageo myocardial de&elopment determinethe ability to handle the shunt.

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Patent Ductus Arteriosus

#he most reliable non-in&asi&ediagnostic tool is echocardiographywith Doppler ultrasound.

'n most inants, a modifedparasternal short ais &iew o(ers thebest window or "D$ &isuali)ation.

#his &iew o(ers the best opportunityto directly measure the "D$.

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Treatment of PDA

'n the premature inant an importantaspect o "D$ management is *uidinta+e. arly *uid restriction to allow

or little more than insensible andsensible losses will signifcantlyreduce the ris+s o "D$, necroti)ing

enterocolitis, and death at theepense o postnatal weight loss.

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Treatment of PDA

imple *uid restriction along withdiuretic use is oten recommended tocontrol the symptoms o a "D$.

urosemide is commonly used.$lthough urosemide is aprostaglandin agonist, it does not

interere with "D$ closure.

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Treatment of PDA

#he use o oral or, preerably,intra&enous /lyophili)edindomethacinto constrict the

ductus arteriosus has led tosuccessul nonsurgical closure in alarge proportion o treated inants1

the e(ects o indomethacinapparently are best when it isadministered before ! dayso age

and in less mature inants.