Materiały źródłowe

• #1 Patent Ductus Arteriosus – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430758/

  The ductus arteriosus is a fetal vessel that allows the oxygenated blood from the placenta to bypass the fetal lungs in utero. […] In premature infants, the ductus arteriosus does not close rapidly and may require pharmacologic or surgical closure to treat unwanted repercussions. […] Describe the management options for patent ductus arteriosus. […] Conservative management includes careful fluid restriction (110 to 130ml/kg/d while monitoring urine output) and increasing peak end-expiratory pressure (PEEP) to treat pulmonary edema. […] Pharmacologic treatment with indomethacin, ibuprofen, or acetaminophen/paracetamol should be considered for preterm infants with a symptomatic PDA. […] For those infants who are symptomatic despite conservative management (increasing PEEP and restricting fluid), there are three choices for pharmacologic treatment: indomethacin, ibuprofen, and acetaminophen/paracetamol.

• #1 Patent Ductus Arteriosus (PDA) | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/patent-ductus-arteriosus-pda

  The ductus arteriosus is a blood vessel that is formed during fetal growth. […] In some babies, however, the ductus arteriosus stays open (patent). When this happens, it can make the heart work harder. […] PDA can happen to any baby. It may be more common in babies born early (premature), born as females, with neonatal respiratory distress syndrome, with other genetic disorders, such as Down syndrome, whose mother had rubella during pregnancy. […] Signs and symptoms include not feeding well, a heart murmur, poor weight gain, fast breathing, getting tired easily, low oxygen levels in premature babies, and sweating during a feeding. […] For full-term babies, the health care provider looks for a PDA after hearing a heart murmur at a check-up. […] A PDA may shrink and go away on its own and treatment may not be needed. If a PDA is small, the health care provider may not treat it right away.

• #1 When Your Child Has a Patent Ductus Arteriosus (PDA) | Saint Luke’s Health System

  https://www.saintlukeskc.org/health-library/when-your-child-has-patent-ductus-arteriosus-pda

  Your child has been diagnosed with a patent ductus arteriosus (PDA). A PDA can lead to heart and lung function that gets worse over time. But it can be easily treated. […] If the PDA is large, too much blood goes to the lungs and recirculates to the left ventricle. This can cause fluid buildup in the lungs (pulmonary edema) and enlargement of the left side of the heart. Then the baby has a hard time breathing and feeding. […] In severe cases, the increased blood flow to the lungs and overwork of the left ventricle can lead to congestive heart failure (CHF). This is a condition in which the heart no longer pumps blood well. […] Most children with a small PDA have no symptoms. Children with a large PDA are more likely to have symptoms. These can include: Trouble breathing or rapid breathing, Trouble feeding, Slow weight gain, Infection of the small intestine (necrotizing enterocolitis), Frequent respiratory infections, Heart murmur.

• #1 Patent Ductus Arteriosus | UCSF Department of Surgery

  https://pedctsurgery.ucsf.edu/condition/patent-ductus-arteriosus

  Some infants may develop signs or symptoms of volume overload on the heart and excess blood flow in the lungs. Signs and symptoms may include: Fast breathing, working hard to breathe, or shortness of breath. Premature infants may need increased oxygen or help breathing from a ventilator. […] Patent ductus arteriosus (PDA) is treated with medicines, catheter-based procedures, and surgery. The goal of treatment is to close the PDA to prevent complications and reverse the effects of increased blood volume. […] Small PDAs often close without treatment. For full-term infants, treatment is needed if the child’s PDA is large or causing health problems. […] For premature infants, treatment is needed if the PDA is causing breathing problems or heart problems. […] Your child’s doctor may prescribe medicines to help close your child’s PDA.

• #1 Patent Ductus Arteriosus Nursing Care and Management – Nurseslabs

  https://nurseslabs.com/patent-ductus-arteriosus/

  Nursing management for a patient with patent ductus arteriosus include: […] Assessment should focus on: […] The nurse should assess for weakness, fatigue, dizziness, a sense of pulsing, and even sleep disorders. […] Circulatory assessment should include history trigger conditions, history of heart murmurs and palpitations, BP, and pulse pressure. […] The nurse should assess for dysphagia and changes in body weight. […] Based on the assessment data, the major nursing diagnoses include: […] The major goals for the patient are: […] Maintain adequate cardiac output. […] Reduce the increase in pulmonary vascular resistance. […] Maintain adequate levels of activity. […] Provide support for growth and development. […] Maintain appropriate weight and height development. […] Patent ductus arteriosus necessitates careful monitoring, patient and family teaching, and emotional support.

• #1 Patent Ductus Arteriosus Nursing Care and Management – Nurseslabs

  https://nurseslabs.com/patent-ductus-arteriosus/

  Watch carefully for signs of PDA in premature infants. […] Frequently assess vital signs, ECG, electrolyte levels, and intake and output. […] If the infant receives indomethacin for ductus closure, watch for possible adverse effects, such as diarrhea, jaundice, bleeding, and renal dysfunction. […] Before surgery, carefully explain all treatments and tests to parents, including the child, and tell them about expected IV lines, monitoring equipment, and postoperative procedures. […] Immediately after surgery, the child may have a central venous pressure catheter and an arterial line in place, so careful assessment of vital signs, intake and output, and arterial and venous pressures are needed, as well as pain relief. […] Expected outcomes include: […] Reduced the increase in pulmonary vascular resistance.

• #1 Patent Ductus Arteriosus (PDA): Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/17325-patent-ductus-arteriosus-pda

  Healthcare providers may treat PDA with surgical procedures, including: Cardiac catheterization: During cardiac catheterization, experts insert a thin, flexible tube (catheter) into the groin and thread it up through a blood vessel to the heart. They insert a plug or coil into the heart through the catheter to close the PDA and stop patent ductus arteriosus blood flow. Providers typically don’t perform cardiac catheterization on premature babies, though older babies and children can have this procedure. […] After catheterization or surgery, blood flow returns to normal immediately if there are no other heart defects. […] Follow all instructions from your healthcare provider. Keep all follow-up appointments and let your provider know right away if your baby develops new symptoms. […] Call your provider if your baby develops new symptoms. If your baby has trouble breathing, seek emergency care right away.

• #1 Patent Ductus Arteriosus (PDA) Treatment & Management: Approach Considerations, Conservative Management, Pharmacologic Management

  https://emedicine.medscape.com/article/891096-treatment

  Closure of the patent ductus arteriosus (PDA) is stimulated by administration of prostaglandin synthesis inhibitors, such as indomethacin or aspirin, which is effective in premature infants. Indomethacin (0.1 mg/kg body weight) is administered orally at 8-hour intervals. This treatment is particularly valuable in premature infants presenting with respiratory distress syndrome complicated by left-to-right shunting through the ductus. […] Surgical ligation or surgical ligation and division remain the standard treatment of large patent ductus arteriosus (PDA) that require treatment in infancy. This is a particularly successful, low-risk procedure in the hands of an experienced pediatric cardiovascular surgeon. This is true even in the smallest premature babies. Ligation (with or without division of the patent ductus arteriosus [PDA]) without cardiopulmonary bypass can be performed through a left posterolateral thoracotomy. Video-assisted thoracoscopic surgery (VATS) ligation of patent ductus arteriosus (PDA) is less invasive than the posterolateral thoracotomy and has been shown to be safe and effective.

• #1 Patent Ductus Arteriosus Nursing Care and Management – Nurseslabs

  https://nurseslabs.com/patent-ductus-arteriosus/

  Maintained adequate levels of activity. […] Provided support for growth and development. […] Maintained appropriate weight and height development. […] Before discharge, the following should be reviewed with the patient and the family: […] Review instructions with parents about activity restrictions based on the child’s tolerance and energy levels. […] Advise the parents not to be overprotective as the child’s tolerance for physical activity increases. […] Stress the need for regular follow-up examinations. […] Advise parents to inform any practitioner who treats his child about his history of surgery for PDA-even if the child is treated for an unrelated medical problem. […] The focus of documentation should include: […] Clients understanding of individual risks and safety concerns.

• #1 Patent Ductus Arteriosus (PDA) – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/topic/default?id=patent-ductus-arteriosus-pda-90-P01811

  Most infants with PDA eat and grow normally. Some premature infants or those infants with large PDAs may get tired when feeding. They may not be able to eat enough to gain weight. […] Surgery can close PDAs. Surgical closure is often advised for babies younger than 6 months who have large defects and symptoms such as poor weight gain and fast breathing. […] If not treated, PDA may lead to long-term lung damage. […] If your baby is discharged home before having a repair procedure, you will be shown how to feed and give medicine to your baby. […] Your child’s cardiac team will talk about pain control before your child goes home. […] In children born full-term, early diagnosis and repair of PDA lets them live normal, healthy lives. […] Talk with your child’s cardiologist about your child’s outlook.

• #1 Patent ductus arteriosus (PDA) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/patent-ductus-arteriosus/diagnosis-treatment/drc-20376150

  Our caring team of Mayo Clinic experts can help you with your Patent ductus arteriosus (PDA)-related health concerns. […] Some people with small PDAs may only need regular health checkups to watch for complications. A premature baby born with patent ductus arteriosus also needs regular checkups to make sure the opening closes. […] Some people born with PDA need regular health checkups for life, even after treatment to close the opening. During these checkups, a healthcare professional may do tests to check for complications. Talk with your healthcare professional about your care plan. Ideally, it’s best to seek care from a doctor trained in treating adults with heart conditions before birth. This type of doctor is called a congenital cardiologist. […] Anyone born with a patent ductus arteriosus needs to take steps to keep the heart healthy and prevent complications. These tips can help.

• #1 Patent Ductus Arteriosus (PDA) Treatment & Management: Approach Considerations, Conservative Management, Pharmacologic Management

  https://emedicine.medscape.com/article/891096-treatment

  Parents of children with this lesion should be aware that patent ductus arteriosus (PDA) does not have any significant inheritance pattern. Once the patent ductus arteriosus (PDA) is closed, no special limitations or care is necessary. No exercise restriction is required in the absence of pulmonary hypertension. Most physicians recommend antibiotic prophylaxis at times of risk of bacteremia for 6-12 months following closure, whether by catheter or surgery. Although rare reports exist of recanalization and recurrence of a left-to-right shunt after patent ductus arteriosus (PDA) ligation, the risk is extremely low. If a patent ductus arteriosus (PDA) has been closed by interventional radiologic techniques, obtaining follow-up echocardiograms echocardiography 2-3 weeks after the procedure until complete closure is confirmed is wise.

• #1 Patent Ductus Arteriosus – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430758/

  If the PDA is hemodynamically significant despite pharmacologic therapy and results in increased respiratory support or renal impairment, or if there are contraindications to the use of pharmacologic therapy, surgical ligation can be performed. […] PDA is not an uncommon finding in neonates. […] The care of an infant with a PDA is always done by a nurse. […] The outcome for the majority of patients in whom the PDA is ligated or medically treated is good. […] After the closure of the PDA, most children have a normal life expectancy. […] Spontaneous closure of the PDA is rare. […] The surgical mortality for ductus varies from 2-20% depending on the infant’s age and other co-existing comorbidities. […] Endocarditis prophylaxis is required for the first 6 months after closure.

• #1 Patent Ductus Arteriosus (PDA) Treatment & Management: Approach Considerations, Conservative Management, Pharmacologic Management

  https://emedicine.medscape.com/article/891096-treatment

  Typically, hospitalization following treatment for patent ductus arteriosus (PDA) is minimal. Patients who have catheter closure of patent ductus arteriosus (PDA) are usually sent home on the day of the procedure. Even patients who have standard surgery with a thoracotomy rarely are hospitalized for longer than 2 or 3 days. The appropriate care and length of hospitalization of premature neonates with a patent ductus arteriosus (PDA) are primarily determined based on abnormalities of other organ systems. However, babies who have effective closure of patent ductus arteriosus (PDA) appear to have shorter hospital stays than babies whose patent ductus arteriosus (PDA) remains a problem. […] Complications of untreated patent ductus arteriosus (PDA) include bacterial endocarditis, late congestive heart failure (CHF), and the development of pulmonary vascular obstructive disease. Patent ductus arteriosus (PDA) can complicate other circulatory or ventilatory abnormalities.

• #1 Nursing Assessment, Education, and Care of Extremely Premature Neonates with Patent Ductus Arteriosus – PubMed

  https://pubmed.ncbi.nlm.nih.gov/27197951/

  The care of extremely premature neonates with suspected or confirmed diagnosis of patent ductus arteriosus (PDA) is a frequent challenge for pediatric nurses. It is important for nurses to have adequate knowledge of the normal postnatal changes in cardiovascular and pulmonary function to recognize any adverse symptoms. Nurses caring for these vulnerable neonates must have a thorough understanding of the pathophysiology of a PDA in order to assess, plan, and implement patient-centered care. Recognition of characteristic symptoms of PDA in a timely manner is essential for optimal management and outcomes. Understanding the science behind treatment options is also imperative for pediatric nurses to provide the best care and effectively educate parents. Pediatric nurses are a significant resource in managing extremely premature neonates through comprehensive assessment, effective parent education, and high-quality patient-centered care.

• #2 Patent Ductus Arteriosus (PDA): Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/17325-patent-ductus-arteriosus-pda

  Patent ductus arteriosus (PDA) is a heart condition that affects some babies (more often, those born prematurely). PDA causes problems with blood flow between the heart and lungs. PDA sometimes resolves on its own. When it doesn’t, healthcare providers treat PDA and restore normal circulation with medication, catheterization and surgery. […] Your healthcare provider will consider your baby’s age, size and health when determining a treatment plan. They might recommend observation (watchful waiting) to see if the PDA will close on its own. A watchful waiting approach involves regular checkups and tests so the provider can see if the PDA is closing. Occasionally, treatment may not be necessary. […] Healthcare providers may treat patent ductus arteriosus with medication, including nonsteroidal anti-inflammatory drugs (NSAIDs). Medications may encourage patent ductus arteriosus closure. This is commonly used in premature babies, but not in older children or adults.

• #2 Patent Ductus Arteriosus | UCSF Department of Surgery

  https://pedctsurgery.ucsf.edu/condition/patent-ductus-arteriosus

  Patent ductus arteriosus (PDA) is a heart problem that occurs soon after birth in some babies. In PDA, abnormal blood flow occurs between two of the major arteries connected to the heart. […] If your baby has a PDA but an otherwise normal heart, the PDA may shrink and go away. Some children need treatment to close their PDAs. […] This helps maintain blood flow and oxygen levels until doctors can do corrective surgery for the heart defect. […] PDA is a relatively common congenital heart defect in the United States. The condition occurs more often in premature infants (on average, occurring in about 8 of every 1,000 births). However, PDA also occurs in full-term infants (on average, occurring in about 2 of every 1,000 births). […] A heart murmur may be the only sign that a baby has patent ductus arteriosus (PDA).

• #2 Patent Ductus Arteriosus (PDA): Symptoms & Causes | NewYork-Presbyterian

  https://www.nyp.org/heart/congenital-heart-disease/patent-ductus-arteriosus-pda

  Patent Ductus Arteriosus (PDA) is a condition where the tube of the ductus arteriosus, a fetal artery in the heart, remains open at birth and does not close. This opening causes extra blood to be pumped into the lung arteries, which may cause the heart and lungs to be overworked. […] Symptoms of PDA depend upon the size of the remaining tube. With a tiny PDA, there may be no symptoms at all, and it might not be discovered for many years, if ever. With very large PDAs, the baby can be very ill soon after birth. […] If your baby has only a small patent ductus arteriosus, they might not have any symptoms. The patent ductus arteriosus might not even be diagnosed unless your doctor hears a heart murmur (usually not in the newborn period). But if its larger, your baby may have the following symptoms: Fatigue, Sweating, Rapid breathing, Heavy breathing, Congested breathing, Trouble feeding, Poor weight gain, Rapid heartbeat.

• #2 When Your Child Has a Patent Ductus Arteriosus (PDA) | Saint Luke’s Health System

  https://www.saintlukeskc.org/health-library/when-your-child-has-patent-ductus-arteriosus-pda

  Your child has been diagnosed with a patent ductus arteriosus (PDA). A PDA can lead to heart and lung function that gets worse over time. But it can be easily treated. […] If the PDA is large, too much blood goes to the lungs and recirculates to the left ventricle. This can cause fluid buildup in the lungs (pulmonary edema) and enlargement of the left side of the heart. Then the baby has a hard time breathing and feeding. […] In severe cases, the increased blood flow to the lungs and overwork of the left ventricle can lead to congestive heart failure (CHF). This is a condition in which the heart no longer pumps blood well. […] Most children with a small PDA have no symptoms. Children with a large PDA are more likely to have symptoms. These can include: Trouble breathing or rapid breathing, Trouble feeding, Slow weight gain, Infection of the small intestine (necrotizing enterocolitis), Frequent respiratory infections, Heart murmur.

• #2

  https://step2.medbullets.com/cardiovascular/120004/patent-ductus-arteriosus-pda

  if unfixed, a large PDA can cause left-to-right shunting in the heart, which increases pulmonary blood flow and causes alterations in the pulmonary vasculature; shifting of blood from systemic circulation can cause cyanosis; over time, with severe defects, this eventually results in pulmonary hypertension and Eisenmenger syndrome. […] Symptoms usually occur with larger defects: respiratory distress, poor feeding, poor weight gain, easy fatigability. […] Physical exam: cardiac auscultation reveals continuous machine-like or to-and-fro murmur, wide pulse pressure, bounding arterial pulses, cyanosis and clubbing of lower extremities, signs of respiratory distress such as tachypnea, grunting, nasal flaring, retractions during breathing. […] Management approach: many lesions may close spontaneously; premature infants often need medical or surgical treatment.

• #2 Patent Ductus Arteriosus Nursing Diagnosis & Care Plan – NurseStudy.Net

  https://nursestudy.net/patent-ductus-arteriosus-nursing-diagnosis/

  Patent ductus arteriosus (PDA) is a congenital heart defect where the ductus arteriosus, a fetal blood vessel connecting the pulmonary artery to the aorta, fails to close after birth. This condition can lead to various complications, including heart failure and pulmonary hypertension. Nursing diagnosis and care planning are crucial for managing patients with PDA effectively. […] The nursing assessment is crucial for identifying the severity of PDA and its impact on the patients overall health. Here are key components of the nursing assessment for PDA: […] Effective nursing interventions are essential for managing patients with patent ductus arteriosus and promoting optimal outcomes. Here are the interventions: […] Nursing diagnosis and care planning are crucial for managing patients with PDA effectively.

• #2 Patent Ductus Arteriosus Nursing Diagnosis & Care Plan – NurseStudy.Net

  https://nursestudy.net/patent-ductus-arteriosus-nursing-diagnosis/

  The following are common nursing care planning goals and expected outcomes for patients with patent ductus arteriosus: […] The patient will maintain adequate oxygenation and tissue perfusion. […] The patient will demonstrate improved feeding patterns and weight gain (in infants). […] The patient will show signs of decreased work of breathing. […] The patient will have stable vital signs within normal limits for age. […] Patient/caregiver will verbalize understanding of PDA and its management. […] The patient will demonstrate improved exercise tolerance (in older children and adults). […] The patient will have no signs of complications (e.g., heart failure, endocarditis).

• #2 Patent Ductus Arteriosus Nursing Care and Management – Nurseslabs

  https://nurseslabs.com/patent-ductus-arteriosus/

  Maintained adequate levels of activity. […] Provided support for growth and development. […] Maintained appropriate weight and height development. […] Before discharge, the following should be reviewed with the patient and the family: […] Review instructions with parents about activity restrictions based on the child’s tolerance and energy levels. […] Advise the parents not to be overprotective as the child’s tolerance for physical activity increases. […] Stress the need for regular follow-up examinations. […] Advise parents to inform any practitioner who treats his child about his history of surgery for PDA-even if the child is treated for an unrelated medical problem. […] The focus of documentation should include: […] Clients understanding of individual risks and safety concerns.

• #2 Patent Ductus Arteriosus (PDA) Treatment & Management: Approach Considerations, Conservative Management, Pharmacologic Management

  https://emedicine.medscape.com/article/891096-treatment

  General measures in prehospital and emergency department (ED) care for a patient with suspected PDA consist of supplemental oxygen for any hypoxia, pulmonary support, and supportive care. Other measures include sodium and fluid restriction as well as correction of any anemia. […] Because patients presenting with a patent ductus arteriosus (PDA) are usually asymptomatic, no acute management is needed. However, until the patency of the ductus is corrected, administer antibiotics in patients during instances of high exposure to bacteremia (eg, instrumentation, dental procedures), as recommended by the American Heart Association for the prevention of bacterial endocarditis. Conservative standards include adaptation of ventilation by lowering inspiratory time and giving more positive end expiratory pressure (PEEP). Furthermore, fluid restriction that does not exceed 130 mL/kg/d beyond day 3 is also used. This has been found to have a high closure rate of patent ductus arteriosus (PDA). In infants who present with congestive heart failure (CHF), the standard treatment of digoxin and diuretic therapy usually palliates the condition. These children can be treated until they are several years old and are good candidates for ductal closure. When medical treatment of congestive heart failure fails in infants, the patients are referred early for surgical closure of the structure.

• #2 Patent Ductus Arteriosus (PDA) NCLEX Review

  https://www.registerednursern.com/patent-ductus-arteriosus-pda-nclex-review/

  Medication (NSAIDs) to close the ductus arteriosus: Prostaglandin inhibitors, Indomethacin. […] This is for premature babies or some young infants that are days old. It won’t work for older infants or children or adults. […] For children: heart catheterization: a device is used to shut the opening or surgery is performed to tie the structure shut.

• #2 Patent Ductus Arteriosus – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430758/

  The ductus arteriosus is a fetal vessel that allows the oxygenated blood from the placenta to bypass the fetal lungs in utero. […] In premature infants, the ductus arteriosus does not close rapidly and may require pharmacologic or surgical closure to treat unwanted repercussions. […] Describe the management options for patent ductus arteriosus. […] Conservative management includes careful fluid restriction (110 to 130ml/kg/d while monitoring urine output) and increasing peak end-expiratory pressure (PEEP) to treat pulmonary edema. […] Pharmacologic treatment with indomethacin, ibuprofen, or acetaminophen/paracetamol should be considered for preterm infants with a symptomatic PDA. […] For those infants who are symptomatic despite conservative management (increasing PEEP and restricting fluid), there are three choices for pharmacologic treatment: indomethacin, ibuprofen, and acetaminophen/paracetamol.

• #2 Patent Ductus Arteriosus | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/patent-ductus-arteriosus

  The goal is to close the patent ductus arteriosus before the lungs become damaged from too much blood flow. In premature infants, medications may help close the patent ductus. These medications include indomethacin, ibuprofen, Tylenol, each working by stimulating the muscles inside the patent ductus arteriosus to tighten, closing the connection. Your child’s physician can answer any questions you may have about this treatment. […] In many cases your child’s patent ductus arteriosus may be repaired by a cardiac catheterization procedure. During cardiac catheterization, your child is sedated and a small, thin, flexible tube (catheter) is inserted into a blood vessel in the groin and guided through the inside of the heart into the patent ductus arteriosus. Once the catheter is in the patent ductus arteriosus, the cardiologist will use this catheter to place a special device, called an occluder, which is designed to completely seal the ductus, preventing blood from flowing through it.

• #2 Pediatric Patent Ductus Arteriosus (PDA) | Memorial Hermann

  https://memorialhermann.org/services/conditions/pediatric-patent-ductus-arteriosus

  A larger PDA in a very small, premature infant may be closed with surgery via an incision between the child’s ribs (thoracotomy) to reach the open ductus arteriosus. The ductus is surgically closed with a clip or may be tied shut with a surgical band. With surgery, the child remains in the hospital for a few days before returning home. […] Long-term follow-up care is not needed, unless the child has other health issues. For six months after a closure device is implanted, the child could develop infective endocarditis, an inflammation of the heart’s lining or valves; therefore, the doctor will prescribe antibiotics before dental or other surgery. After the first six months, this precaution is no longer necessary.

• #2 Patent Ductus Arteriosus (PDA) Treatment & Management: Approach Considerations, Conservative Management, Pharmacologic Management

  https://emedicine.medscape.com/article/891096-treatment

  Closure of the patent ductus arteriosus (PDA) is stimulated by administration of prostaglandin synthesis inhibitors, such as indomethacin or aspirin, which is effective in premature infants. Indomethacin (0.1 mg/kg body weight) is administered orally at 8-hour intervals. This treatment is particularly valuable in premature infants presenting with respiratory distress syndrome complicated by left-to-right shunting through the ductus. […] Surgical ligation or surgical ligation and division remain the standard treatment of large patent ductus arteriosus (PDA) that require treatment in infancy. This is a particularly successful, low-risk procedure in the hands of an experienced pediatric cardiovascular surgeon. This is true even in the smallest premature babies. Ligation (with or without division of the patent ductus arteriosus [PDA]) without cardiopulmonary bypass can be performed through a left posterolateral thoracotomy. Video-assisted thoracoscopic surgery (VATS) ligation of patent ductus arteriosus (PDA) is less invasive than the posterolateral thoracotomy and has been shown to be safe and effective.

• #2 Patent Ductus Arteriosus (PDA): Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/17325-patent-ductus-arteriosus-pda

  Healthcare providers may treat PDA with surgical procedures, including: Cardiac catheterization: During cardiac catheterization, experts insert a thin, flexible tube (catheter) into the groin and thread it up through a blood vessel to the heart. They insert a plug or coil into the heart through the catheter to close the PDA and stop patent ductus arteriosus blood flow. Providers typically don’t perform cardiac catheterization on premature babies, though older babies and children can have this procedure. […] After catheterization or surgery, blood flow returns to normal immediately if there are no other heart defects. […] Follow all instructions from your healthcare provider. Keep all follow-up appointments and let your provider know right away if your baby develops new symptoms. […] Call your provider if your baby develops new symptoms. If your baby has trouble breathing, seek emergency care right away.

• #2 Patent Ductus Arteriosus (PDA) | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/patent-ductus-arteriosus-pda

  The most common three options for treatment are medicines, surgery, and a catheter-based procedure. […] Indomethacin is a medicine that helps close a PDA in premature infants by making it tighten up. […] This procedure is called cardiac catheterization. It is the most common way to close the PDA and can be done for older babies and patients. […] Surgery for PDA may be done if the catheter procedure does not work or is not possible. […] Your child will be in the hospital for a few days. Most children go home two days after surgery. […] All children with an open PDA have a higher risk of infection in the heart, called bacterial endocarditis. […] You should call 911 if your baby is short of breath, is working hard to breathe, coughs up blood, or has skin turn blue around their mouth or fingertips. […] You should call your health care provider if your baby has a fever, has chills, a cough, or sounds congested, or if the skin around the surgery cut is red, swollen, or has pus draining from it.

• #2 Patent Ductus Arteriosus (PDA) – Conditions and Treatments | Children’s National Hospital

  https://www.childrensnational.org/get-care/health-library/patent-ductus-arteriosus-pda

  Most infants and older children feel comfortable when they go home. […] Pain medications, such as acetaminophen or ibuprofen, may be recommended to keep your child comfortable. […] After surgery, older children usually have a fair tolerance for activity. […] You will receive additional instructions from your child’s doctors and the hospital staff. […] In children born full-term, the vast majority that had a patent ductus arteriosus diagnosed and repaired early will live healthy lives after recovering from the hospitalization. […] Consult your child’s doctor regarding the specific outlook for your child.

• #2 Patent Ductus Arteriosus (PDA)

  https://healthlibrary.methodisthealthsystem.org/Library/DiseasesConditions/Pediatric/Cardiology/90,P01811

  When your child is discharged after the PDA repair, you may give them pain medicine such as acetaminophen or ibuprofen to keep them comfortable. Your child’s cardiac team will talk about pain control before your child goes home. […] In children born full-term, early diagnosis and repair of PDA lets them live normal, healthy lives. Activity levels, appetite, and growth should return to normal. Your child’s cardiologist may advise that your child take antibiotics to prevent infection in the heart lining and valves (bacterial endocarditis).

• #2 Patent Ductus Arteriosus | Cornell University College of Veterinary Medicine

  https://www.vet.cornell.edu/hospitals/services/cardiology/patent-ductus-arteriosus

  This will depend on the procedure that was used to correct the PDA. If a thoracotomy is performed the sutures will have to be removed in 7-10 days. Make sure bandages, chest wraps, and stitched incisions (sutures) stay clean and dry after surgery. If they become wet, are chewed at or damaged by the pet, or otherwise seem abnormal, contact your veterinarian for a recheck to reduce the risk of infection or other problems. If catheter based occlusion is performed, sutures will also have to be removed in 7-10 days. Usually, a repeat echocardiogram is acquired 1-3 months post PDA closure. Long-term follow-up appointments may occasionally be needed if there was any possibility of long-standing effects (permanent damage) to the heart or if your animal is taking any cardiac medication.

• #2 Patent Ductus Arteriosus | 5-Minute Pediatric Consult

  https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617572/all/Patent_Ductus_Arteriosus

  If PDA persists or patient is symptomatic, closure of PDA is indicated. Medical closure: Indomethacin is most often used; ibuprofen is as effective. Meta-analysis of controlled and uncontrolled studies has demonstrated an efficacy of paracetamol (acetaminophen) comparable with that reported for ibuprofen. […] Surgical closure is indicated if medical treatment fails or use of indomethacin is contraindicated. […] Closure is indicated whenever a symptomatic or hemodynamically significant PDA exists. […] Most infants and children can have a PDA safely and effectively closed during cardiac catheterization, obviating the need for a surgical procedure. […] After closure of PDA, no endocarditis prophylaxis is needed if complete obliteration of flow is achieved. Most cardiologists continue prophylaxis for 6 months after the procedure that closed the PDA if closed by a coil or device.

• #2 Patent Ductus Arteriosus (PDA) – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/topic/default?id=patent-ductus-arteriosus-pda-90-P01811

  Most infants with PDA eat and grow normally. Some premature infants or those infants with large PDAs may get tired when feeding. They may not be able to eat enough to gain weight. […] Surgery can close PDAs. Surgical closure is often advised for babies younger than 6 months who have large defects and symptoms such as poor weight gain and fast breathing. […] If not treated, PDA may lead to long-term lung damage. […] If your baby is discharged home before having a repair procedure, you will be shown how to feed and give medicine to your baby. […] Your child’s cardiac team will talk about pain control before your child goes home. […] In children born full-term, early diagnosis and repair of PDA lets them live normal, healthy lives. […] Talk with your child’s cardiologist about your child’s outlook.

• #2

  https://step2.medbullets.com/cardiovascular/120004/patent-ductus-arteriosus-pda

  Indomethacin: first-line therapy for all patients who do not need the PDA; patients with certain congenital cardiac abnormalities that result in the separation of the systemic and pulmonary circulation may require a shunt between the two systems, such as the PDA, to sustain life; premature infants with PDA. […] Surgical closure: indications include failure of PDA to close after medical therapy and term infants with large PDAs; contraindications include severe pulmonary vascular disease (e.g., pulmonary hypertension). […] Complications: heart failure, Eisenmenger syndrome, infective endocarditis. […] Prognosis: typically progresses over time.

• #2 Patent Ductus Arteriosus Nursing Care and Management – Nurseslabs

  https://nurseslabs.com/patent-ductus-arteriosus/

  Availability and use of resources. […] Current and previous level of function. […] Level of anxiety and precipitating/aggravating factors. […] Description of feelings. […] Awareness and ability to recognize and express feelings. […] Plan of care. […] Teaching plan. […] Client involvement and response to interventions, teaching, and actions performed. […] Attainment or progress toward desired outcomes. […] Modifications to plan of care. […] Long term needs.

• #2

  https://he02.tci-thaijo.org/index.php/journalthaicvtnurse/article/view/249860

  In preterm, failure or delay in spontaneous closure of Ductus Arteriosus (DA), resulting in the condition of Patent Ductus Arteriosus (PDA), blood from the Aorta flow to the Pulmonary artery to the lung. […] Prophylaxis and treatment are necessary for PDA closure. […] Nurses should play important roles to care for preterm. Nurses can earlier detect signs and symptoms of PDA, provide an accurate dosage of medicine, monitor post-operation care, prevent complications for efficacy, and higher safety for PDA closure in preterm.

• #2 Patent Ductus Arteriosus – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430758/

  If the PDA is hemodynamically significant despite pharmacologic therapy and results in increased respiratory support or renal impairment, or if there are contraindications to the use of pharmacologic therapy, surgical ligation can be performed. […] PDA is not an uncommon finding in neonates. […] The care of an infant with a PDA is always done by a nurse. […] The outcome for the majority of patients in whom the PDA is ligated or medically treated is good. […] After the closure of the PDA, most children have a normal life expectancy. […] Spontaneous closure of the PDA is rare. […] The surgical mortality for ductus varies from 2-20% depending on the infant’s age and other co-existing comorbidities. […] Endocarditis prophylaxis is required for the first 6 months after closure.

• #3 Patent Ductus Arteriosus (PDA)

  https://healthlibrary.vidanthealth.com/search/90,P01811

  PDA occurs twice as often in girls as in boys. […] Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. […] A small PDA will often close on its own as your child grows. A PDA that causes symptoms will need to be treated with medicine, cardiac catheterization, or surgery. The cardiologist will check from time to time to see if the PDA is closing on its own. If a PDA does not close, it will be fixed to prevent lung problems. Treatment may include the following. […] Your baby may need medicines to help the heart work better. […] In premature infants, the medicine indomethacin may help close the PDA. It’s given through an IV (intravenous) line. Indomethacin stimulates the muscles inside the PDA to tighten. This closes the connection. Your child’s cardiologist can answer any questions you may have about this treatment.

• #3 Patent Ductus Arteriosus – Pediatric Heart Specialists

  https://pediatricheartspecialists.com/heart-education/15-congenital-heart-defects/172-patent-ductus-arteriosus

  The ductus arteriosus is small blood vessel connecting the pulmonary artery to the aorta. […] A PDA is considered a congenital heart defect, in other words, a birth defect of the heart. […] PDAs are much more commonly found in premature infants as opposed to full term infants. […] Symptoms from a PDA are related to excess blood flow to the lungs. […] In patients who develop symptoms, the most common finding is a rapid respiratory rate. […] Other symptoms in infants include sweating with exertion, poor feeding due to fatigue, and poor weight gain. […] Diagnosis of a PDA can be made in a number of different ways. […] An echocardiogram uses sound waves to visualize the intracardiac structures and is the easiest way to diagnose the size and location of a PDA. […] There is a wide spectrum of treatment options for a patient with a PDA.

• #3 Nursing Assessment, Education, and Care of Extremely Premature Neonates with Patent Ductus Arteriosus – PubMed

  https://pubmed.ncbi.nlm.nih.gov/27197951/

  The care of extremely premature neonates with suspected or confirmed diagnosis of patent ductus arteriosus (PDA) is a frequent challenge for pediatric nurses. It is important for nurses to have adequate knowledge of the normal postnatal changes in cardiovascular and pulmonary function to recognize any adverse symptoms. Nurses caring for these vulnerable neonates must have a thorough understanding of the pathophysiology of a PDA in order to assess, plan, and implement patient-centered care. Recognition of characteristic symptoms of PDA in a timely manner is essential for optimal management and outcomes. Understanding the science behind treatment options is also imperative for pediatric nurses to provide the best care and effectively educate parents. Pediatric nurses are a significant resource in managing extremely premature neonates through comprehensive assessment, effective parent education, and high-quality patient-centered care.

• #3 Patent Ductus Arteriosus Nursing Diagnosis & Care Plan – NurseStudy.Net

  https://nursestudy.net/patent-ductus-arteriosus-nursing-diagnosis/

  The following are common nursing care planning goals and expected outcomes for patients with patent ductus arteriosus: […] The patient will maintain adequate oxygenation and tissue perfusion. […] The patient will demonstrate improved feeding patterns and weight gain (in infants). […] The patient will show signs of decreased work of breathing. […] The patient will have stable vital signs within normal limits for age. […] Patient/caregiver will verbalize understanding of PDA and its management. […] The patient will demonstrate improved exercise tolerance (in older children and adults). […] The patient will have no signs of complications (e.g., heart failure, endocarditis).

• #3 Patent Ductus Arteriosus (PDA) Treatment & Management: Approach Considerations, Conservative Management, Pharmacologic Management

  https://emedicine.medscape.com/article/891096-treatment

  Spontaneous closure of the patent ductus arteriosus (PDA) is common. If significant respiratory distress or impaired systemic oxygen delivery is present, therapy is usually prudent. Intravenous (IV) indomethacin (or the newer preparation of IV ibuprofen) is frequently effective in closing a PDA if it is administered in the first 10-14 days of life. Other options are catheter closure and surgical ligation, which entails a thoracotomy. Medical management also consists of amelioration of congestive heart failure (CHF) symptoms. CHF is an indication for closure of the PDA in infancy. If medical therapy is ineffective, urgent intervention to close the structure should be undertaken. All PDA should be closed because of the risk of bacterial endocarditis associated with the open structure. Over time, the increased pulmonary blood flow precipitates pulmonary vascular obstructive disease, which is ultimately fatal. Identification of additional cardiac malformations, such as coarctation or interrupted aortic arch or pulmonary atresia, is the most important requirement before pharmacologic or surgical closure of the PDA. When surgical ligation is not indicated, prostaglandin inhibitors (eg, nonsteroid antiinflammatory drugs [NSAIDs]) are used to close the ductus arteriosus. A ductal dependent lesion requires the persistence of a PDA to ensure adequate pulmonary blood flow.

• #3 Patent Ductus Arteriosus | 5-Minute Pediatric Consult

  https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617572/all/Patent_Ductus_Arteriosus

  If PDA persists or patient is symptomatic, closure of PDA is indicated. Medical closure: Indomethacin is most often used; ibuprofen is as effective. Meta-analysis of controlled and uncontrolled studies has demonstrated an efficacy of paracetamol (acetaminophen) comparable with that reported for ibuprofen. […] Surgical closure is indicated if medical treatment fails or use of indomethacin is contraindicated. […] Closure is indicated whenever a symptomatic or hemodynamically significant PDA exists. […] Most infants and children can have a PDA safely and effectively closed during cardiac catheterization, obviating the need for a surgical procedure. […] After closure of PDA, no endocarditis prophylaxis is needed if complete obliteration of flow is achieved. Most cardiologists continue prophylaxis for 6 months after the procedure that closed the PDA if closed by a coil or device.

• #3 Pediatric patent ductus arteriosus (PDA) – Children’s Health Cardiology

  https://www.childrens.com/specialties-services/conditions/patent-ductus-arteriosus

  Medications typically work in the first few weeks in premature infants. The medicines include nonsteroidal anti-inflammatory drugs (NSAIDs) including acetaminophen, ibuprofen and indomethacin. Your child receives these medicines intravenously (IV, through a vein) with close monitoring in the intensive care unit. […] Cardiac catheterization with transcatheter device closure (PDA device closure) Thanks to advances in technology, even babies who weigh as little as 1.5 pounds can have this minimally invasive procedure. Our pediatric interventional cardiologists use a needle puncture in your childs leg to insert a catheter (thin tube with miniaturized instruments). They then guide the catheter through your childs blood vessels and heart chambers and into the PDA. Surgeons can close the PDA with a plug.

• #3 Patent Ductus Arteriosus (PDA) Treatment & Management: Approach Considerations, Conservative Management, Pharmacologic Management

  https://emedicine.medscape.com/article/891096-treatment

  Although indomethacin therapy is preferred in most intensive care nurseries (NICUs) as the first-line approach to effect patent ductus arteriosus (PDA) closure, the benefits of this approach over surgical ligation are not obvious. In most studies that attempt to evaluate differences in the outcomes for indomethacin therapy and surgical closure, results are similar. A Cochrane review failed to demonstrate that the net harm-to-benefit ratio favored either surgical ligation or medical therapy. Observational studies suggest that surgical ligation is associated with higher likelihood of chronic lung disease, retinopathy of prematurity, and neurosensory impairment. […] Complications of surgical ligation are mostly related to the left lateral thoracotomy. Surgical morbidity and mortality rates are negligible, and early postoperative complications are associated with other complications of prematurity. However, possible injury to the aorta, pulmonary artery, and other structures should be noted.

• #3 Patent Ductus Arteriosus (PDA) | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/patent-ductus-arteriosus-pda

  The most common three options for treatment are medicines, surgery, and a catheter-based procedure. […] Indomethacin is a medicine that helps close a PDA in premature infants by making it tighten up. […] This procedure is called cardiac catheterization. It is the most common way to close the PDA and can be done for older babies and patients. […] Surgery for PDA may be done if the catheter procedure does not work or is not possible. […] Your child will be in the hospital for a few days. Most children go home two days after surgery. […] All children with an open PDA have a higher risk of infection in the heart, called bacterial endocarditis. […] You should call 911 if your baby is short of breath, is working hard to breathe, coughs up blood, or has skin turn blue around their mouth or fingertips. […] You should call your health care provider if your baby has a fever, has chills, a cough, or sounds congested, or if the skin around the surgery cut is red, swollen, or has pus draining from it.

• #3 When Your Child Has a Patent Ductus Arteriosus (PDA) | Saint Luke’s Health System

  https://www.saintlukeskc.org/health-library/when-your-child-has-patent-ductus-arteriosus-pda

  Call the healthcare provider right away if your child has any of these: Redness, fluid leaking, swelling, or bleeding at the incision or insertion site that gets worse, Fever 100.4F (38C) or higher, or as directed by your healthcare provider, Trouble feeding, Tiredness, Fast or irregular breathing, Cough that won’t go away, Prolonged nausea or vomiting, Poor feeding or failure to gain weight. […] After repair of a PDA, symptoms related to the defect should go away. Your child should have a heart that works normally.

• #3 Patent Ductus Arteriosus (PDA) | Phoenix Children’s Hospital

  https://phoenixchildrens.org/specialties-conditions/patent-ductus-arteriosus-pda

  If not treated, PDA may lead to long-term lung damage. It can also damage the blood vessels in the lungs. […] If your child is discharged home before having a repair procedure, you will be shown how to feed and give medicine to your child. You will also be taught what symptoms to report to your child’s provider. […] When your child is discharged after the PDA repair, you may give them pain medicine such as acetaminophen or ibuprofen to keep them comfortable. […] In children born full-term, early diagnosis and repair of PDA lets them live normal, healthy lives. Activity levels, appetite, and growth should return to normal. […] Call your child’s provider if your child’s symptoms get worse or if new symptoms develop, especially breathing or feeding problems. […] A small PDA may close on its own as your child grows. If it is large or does not close, your child will need a repair procedure. […] An infant or child with PDA will be cared for by a pediatric cardiologist.

• #3 Patent Ductus Arteriosus – Pediatric Cardiology Associates of Houston

  https://www.kidsheartshouston.com/answers/21866-patent-ductus-arteriosus1

  All patients who undergo surgery for a PDA are required to take antibiotics before any dental or surgical procedures for at least 6 months following the procedure, termed SBE prophylaxis. This precaution is designed to minimize the risk of any bacterial infection forming in the heart tissue. This can happen with dental work and certain forms of surgery. After 6 months, usually the normal heart tissue has sealed things in place sufficiently to no longer require this. […] The long-term outlook for a child undergoing a surgical PDA ligation is very good. The vast majority do well with no significant long-term problems or complications related to the surgery.

• #3 Patent Ductus Arteriosus (PDA): Symptoms & Causes | NewYork-Presbyterian

  https://www.nyp.org/heart/congenital-heart-disease/patent-ductus-arteriosus-pda

  All PDA symptoms are related to blood being diverted from the aorta (body) into the pulmonary artery (lungs). The amount of blood being diverted determines the presence and severity of the baby’s PDA symptoms. […] If a PDA is treated, then your babys long-term outcome is normal. Most children have no need for additional medication, chronic medical care or surgeries. But if left untreated, PDA can be associated with several potentially life-threatening complications. […] Complications for large, unrepaired PDA may include: Congestive heart failure in infancy, Pulmonary edema, Pulmonary hypertension. […] In a smaller PDA, not as much blood can travel to the lungs, and patients are usually not symptomatic. Complications from smaller PDAs include: Endocarditis, Chest pain. […] Routine prenatal care during pregnancy is the main way to prevent premature birth and PDA in your baby. Stay up-to-date on vaccinations, including against rubella before you become pregnant, since this infection raises your babys PDA risk.

• #3 Patent Ductus Arteriosus (PDA) – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/topic/default?id=patent-ductus-arteriosus-pda-90-P01811

  Most infants with PDA eat and grow normally. Some premature infants or those infants with large PDAs may get tired when feeding. They may not be able to eat enough to gain weight. […] Surgery can close PDAs. Surgical closure is often advised for babies younger than 6 months who have large defects and symptoms such as poor weight gain and fast breathing. […] If not treated, PDA may lead to long-term lung damage. […] If your baby is discharged home before having a repair procedure, you will be shown how to feed and give medicine to your baby. […] Your child’s cardiac team will talk about pain control before your child goes home. […] In children born full-term, early diagnosis and repair of PDA lets them live normal, healthy lives. […] Talk with your child’s cardiologist about your child’s outlook.

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