Przetrwały przewód tętniczy

Przetrwały przewód tętniczy
Epidemiologia

Przetrwały przewód tętniczy (PDA) jest jedną z najczęstszych wrodzonych wad serca, szczególnie często występującą u wcześniaków, gdzie częstość sięga nawet 90% u niemowląt urodzonych przed 24 tygodniem ciąży. Częstość występowania PDA u niemowląt urodzonych o czasie wynosi około 1 na 2000 żywych urodzeń, z wyraźną przewagą u dziewczynek (stosunek 2:1). Do czynników ryzyka należą wcześniactwo, niska masa urodzeniowa (<1000 g), zespół zaburzeń oddychania (RDS), zakażenie różyczką u matki, zaburzenia genetyczne (np. zespół Downa), niedotlenienie okołoporodowe oraz poród na dużej wysokości (>3000 m n.p.m.). Diagnostyka opiera się głównie na echokardiografii, która pozwala ocenić średnicę PDA i jego hemodynamiczne znaczenie, a także na badaniu przedmiotowym, RTG klatki piersiowej i EKG. Nowe metody monitorowania, takie jak analiza zależności między zapisami EKG i ciśnienia krwi, mogą poprawić ciągłą ocenę funkcji PDA, zwłaszcza u wcześniaków.

Epidemiologia przetrwałego przewodu tętniczego

Przetrwały przewód tętniczy (Patent Ductus Arteriosus, PDA) jest jedną z najczęstszych wrodzonych wad serca, stanowiąc 5-10% wszystkich wrodzonych wad serca u niemowląt urodzonych o czasie.¹²³ Częstość występowania PDA u niemowląt urodzonych o czasie wynosi około 1 na 2000 żywych urodzeń.¹²³ Jeśli uwzględnić „ciche” PDA (wykrywane przypadkowo podczas badań echokardiograficznych wykonywanych z innych powodów), częstość może wzrosnąć nawet do 1 na 500 żywych urodzeń.¹²

Według niektórych badań, w Stanach Zjednoczonych szacowana częstość występowania PDA u dzieci urodzonych o czasie wynosi od 0,02% do 0,006% żywych urodzeń.¹ Inne źródła podają, że PDA występuje u około 3-8 na 10 000 żywych urodzeń.¹ W Korei badania epidemiologiczne wykazały, że częstość występowania niemowląt z PDA wynosiła 81 na 10 000 żywych urodzeń, z rosnącą tendencją od 70 na 10 000 w 2015 roku do 94 na 10 000 w 2018 roku.¹

Częstotliwość występowania u wcześniaków

Częstość występowania PDA u wcześniaków jest znacznie wyższa i zależy od wieku ciążowego oraz masy urodzeniowej.¹ Szacunki wskazują, że PDA występuje u:

10% niemowląt urodzonych między 30 a 37 tygodniem ciąży
20% niemowląt urodzonych w 32 tygodniu ciąży
80% niemowląt urodzonych między 25 a 28 tygodniem ciąży
90% niemowląt urodzonych przed 24 tygodniem ciąży

¹²³

Badania wskazują, że PDA występuje u 20-60% wszystkich wcześniaków, przy czym częstość jest odwrotnie proporcjonalna do wieku ciążowego i masy urodzeniowej.¹²³ Niemowlęta urodzone z masą ciała poniżej 1000 gramów są w grupie najwyższego ryzyka wystąpienia PDA – w tej populacji 70% będzie miało PDA w 7 dniu życia.¹

U wcześniaków z zespołem zaburzeń oddychania (RDS) częstość występowania PDA jest szczególnie wysoka i wynosi około 80%.¹ Około 20% noworodków z zespołem zaburzeń oddychania ma przetrwały przewód tętniczy.¹

Różnice płciowe w występowaniu PDA

Istnieje wyraźna przewaga występowania PDA u dziewczynek w stosunku do chłopców, z proporcją 2:1.¹²³ Ta przewaga płci żeńskiej nie jest obserwowana w przypadkach, gdy PDA jest związany z określonymi czynnikami teratogennymi, takimi jak wrodzona infekcja różyczką – wówczas częstość występowania jest równa u obu płci.¹

Czynniki ryzyka i współistnienie z innymi wadami

Do czynników zwiększających ryzyko wystąpienia PDA należą:

Wcześniactwo – najczęściej identyfikowany czynnik ryzyka
Niska masa urodzeniowa (szczególnie poniżej 1000 g)
Zespół zaburzeń oddychania noworodków
Zakażenie różyczką (rubella) u matki podczas ciąży
Zaburzenia genetyczne, takie jak zespół Downa
Poród na dużej wysokości (powyżej 3000 m n.p.m.)
Niedotlenienie okołoporodowe
Rodzinne występowanie wrodzonych wad serca

¹²³⁴⁵

PDA współistnieje w około 10% innych wrodzonych wad serca.¹² Jest to istotna informacja z punktu widzenia diagnostyki różnicowej oraz planowania leczenia.

Nadzór i monitorowanie PDA

Metody diagnostyczne

Diagnostyka PDA jest kluczowa dla wczesnego wykrycia i odpowiedniego leczenia. Podstawowe metody diagnostyczne obejmują:

Badanie przedmiotowe – często pierwszym objawem jest szmer serca wykryty podczas rutynowego badania dziecka
Echokardiografia – złoty standard w diagnostyce PDA, pozwalający na potwierdzenie obecności przewodu tętniczego, ocenę jego wielkości oraz hemodynamicznych konsekwencji
Rentgen klatki piersiowej – może wykazać powiększenie serca i zwiększony przepływ płucny
EKG – może wskazywać na przerost lewej komory serca

¹²³

Echokardiografia powinna być używana do potwierdzenia obecności przecieku z lewej na prawą stronę przez PDA przed rozważeniem leczenia.¹ Badanie to pozwala na ocenę średnicy PDA, która jest uważana za najważniejszy parametr określający hemodynamiczną istotność przewodu.¹

Strategie monitorowania

Obecnie monitorowanie PDA u wcześniaków odbywa się głównie poprzez okresowe badania echokardiograficzne, które wymagają znacznej ekspertyzy i czasami nie są dobrze tolerowane przez krytycznie chore wcześniaki.¹ Prowadzone są badania nad nowymi metodami ciągłego monitorowania funkcji PDA, m.in. poprzez analizę zależności między falami EKG i ciśnienia krwi oraz analizę czasową zapisu ciśnienia tętniczego.¹²

Badania pilotażowe wskazują na istotne zależności między średnicą PDA a charakterystyką fali ciśnienia krwi znormalizowanej dla skrajnie wcześnie urodzonych niemowląt. Różnica fazowa między zapisami EKG i ciśnienia krwi, a także charakterystyka fali ciśnienia krwi są stosunkowo łatwe do wdrożenia przy użyciu rutynowo monitorowanych przebiegów i potencjalnie mogłyby zostać włączone do monitorów w celu umożliwienia ciągłej oceny funkcji PDA.¹

Zmiany w strategiach leczenia i ich wpływ na nadzór

W ostatnich latach obserwuje się znaczące zmiany w podejściu do leczenia PDA, co ma wpływ na strategie nadzoru i monitorowania. Dane z Kanadyjskiej Sieci Neonatalnej sugerują wzrost konserwatywnego, niefarmakologicznego leczenia PDA u wcześniaków w ostatnich latach.¹ Podobny trend zaobserwowano w Korei, gdzie podejście konserwatywne stawało się coraz bardziej popularne w latach 2015-2018, podczas gdy stosowanie leków lub leczenia chirurgicznego zmniejszało się.¹

Konserwatywne podejście może obejmować:

Obserwację PDA w pierwszych 1-2 tygodniach po urodzeniu, szczególnie u klinicznie stabilnych wcześniaków
Ograniczenie podaży płynów
Stosowanie diuretyków w celu leczenia przeciążenia płynami spowodowanego niewydolnością serca

¹²

W przypadku gdy PDA wymaga interwencji, stosuje się:

Leczenie farmakologiczne – ibuprofen powinien być rozważany jako farmakoterapia pierwszego wyboru dla objawowego PDA
Drugi kurs farmakoterapii – powinien być rozważany przed inwazyjnym leczeniem przetrwałego, objawowego PDA, jeśli nie ma przeciwwskazań
Zamknięcie przezskórne lub chirurgiczne – może być rozważane u niemowląt z przetrwałym PDA nawet po dwóch kursach farmakoterapii lub u tych z przeciwwskazaniami do farmakoterapii

Wyzwania w nadzorze epidemiologicznym PDA

Standardyzacja definicji i kryteriów diagnostycznych

Istotnym wyzwaniem w nadzorze epidemiologicznym PDA jest brak standardowej definicji i kryteriów diagnostycznych. Zgłaszana częstość występowania PDA może się znacznie różnić z powodu metodologicznych różnic w badanej populacji i definicji PDA.¹ Prowadzi to do znacznych rozbieżności w danych epidemiologicznych i utrudnia porównywanie wyników badań z różnych ośrodków.

Dodatkowo, brakuje opartych na dowodach wytycznych dotyczących optymalnej częstotliwości kontroli i badań u pacjentów z PDA, zarówno przed, jak i po interwencji, co prowadzi do szerokiej zmienności w praktyce klinicznej i wykorzystaniu zasobów.¹

Ocena istotności hemodynamicznej

Istotnym wyzwaniem jest określenie, które przypadki PDA są hemodynamicznie istotne i wymagają interwencji. Hemodynamicznie istotne PDA wiążą się ze znaczącą chorobowością i śmiertelnością, która może sięgać nawet 30%.¹

Skrajnie wcześnie urodzone niemowlęta (wiek ciążowy poniżej 28 tygodni) są w grupie najwyższego ryzyka rozwoju hemodynamicznie istotnego PDA i związanych z nim powikłań.¹ PDA jest powszechnie diagnozowany u skrajnie wcześnie urodzonych niemowląt i jest związany z licznymi patologiami, w tym przewlekłą chorobą płuc (CLD), martwiczym zapaleniem jelit (NEC) i krwawieniem dokomorowym (IVH).²

Różnice w podejściu terapeutycznym

Badania potwierdzają, że istnieją znaczne różnice w leczeniu medycznym stosowanym przed skierowaniem na chirurgiczne podwiązanie PDA.¹ Te różnice mogą wpływać na wyniki leczenia i utrudniają porównywanie danych z różnych ośrodków.

Badania przeprowadzone w Wielkiej Brytanii wykazały, że w okresie badania 263 niemowlęta przeszły podwiązanie PDA, co daje częstość 3,07 na 10 000 żywych urodzeń.¹ Ogólna śmiertelność w tym badaniu wynosiła 6,5%, ze śmiertelnością 30-dniową na poziomie 3%.¹

Szersze wykorzystanie i wdrożenie algorytmów PDA mogłoby poprawić wykorzystanie zasobów i standaryzować opiekę nad pacjentami z izolowanym PDA.¹

Perspektywy i wyzwania na przyszłość

Postępy w metodach diagnostycznych

Ze względu na zwiększone wykorzystanie echokardiografii, przypadkowe wykrywanie bezobjawowego „cichego” PDA wzrasta.¹ Rozwój nowych technologii monitorowania, takich jak ciągła analiza zależności między zapisami EKG i ciśnienia krwi, może potencjalnie poprawić diagnostykę i monitorowanie PDA.¹

Wyzwaniem pozostaje opracowanie standaryzowanych protokołów diagnostycznych, które byłyby zarówno dokładne, jak i praktyczne do zastosowania w różnych warunkach klinicznych, szczególnie w przypadku wcześniaków.

Standaryzacja opieki

Badania sugerują potrzebę standaryzacji zarówno medycznego, jak i chirurgicznego leczenia noworodkowego PDA.¹ Ważne jest opracowanie opartych na dowodach wytycznych dla optymalnej częstotliwości kontroli i badań u pacjentów z PDA.¹

Cel algorytmu klinicznego PDA polega na zapewnieniu osobom opiekującym się pacjentami z wrodzoną wadą serca narzędzia do podejmowania decyzji, które może być stosowane przed i/lub po zabiegach cewnikowania lub chirurgicznych interwencjach w przypadku PDA.¹

Monitorowanie długoterminowych wyników

Większość dzieci z PDA, które zostało zdiagnozowane i naprawione wcześnie, będzie prowadzić zdrowe życie po wyzdrowieniu z hospitalizacji.¹ Jednak u wcześniaków rokowanie po operacji naprawy PDA zależy od wieku ciążowego dziecka i wszelkich innych chorób obecnych u dziecka.²

Długoterminowe monitorowanie jest szczególnie ważne dla pacjentów, którzy mieli duży PDA lub u których wystąpiły powikłania związane z PDA. Niektórzy pacjenci urodzeni z PDA wymagają regularnych kontroli zdrowotnych przez całe życie, nawet po leczeniu zamykającym otwór.¹

Edukacja i świadomość

Badania wskazują na niski poziom świadomości na temat PDA wśród rodziców. W ankiecie przeprowadzonej wśród 190 rodziców, 86% nigdy nie słyszało lub wiedziało niewiele o PDA przed tym, jak ich dziecko miało tę wadę.¹

Zwiększenie świadomości i edukacji na temat PDA wśród rodziców i personelu medycznego może prowadzić do wcześniejszego wykrywania i lepszych wyników leczenia.

Dziedziczność i genetyczne aspekty PDA

Dziedziczność PDA

Interesujące badania na psach rasy Stabyhoun wykazały wysoką dziedziczność PDA. W tej populacji psów odziedziczalność PDA wynosiła 0,51 (0,09) dla populacji referencyjnej i 0,41 (0,10) dla populacji fenotypowej.¹ Chociaż te dane dotyczą populacji psów, sugerują, że genetyczne czynniki ryzyka mogą odgrywać istotną rolę również w występowaniu PDA u ludzi.

Badania potwierdzają, że występowanie PDA w rodzinie może zwiększać ryzyko tej wady u dziecka.¹ Sugeruje to, że czynniki genetyczne przyczyniają się do ryzyka PDA, chociaż dokładne mechanizmy genetyczne nie zostały w pełni wyjaśnione.

PDA w zespołach genetycznych

PDA występuje częściej u dzieci z zaburzeniami genetycznymi, takimi jak zespół Downa.¹² Sugeruje to, że specyficzne aberracje genetyczne mogą predysponować do nieprawidłowego zamknięcia przewodu tętniczego po urodzeniu.

Zrozumienie genetycznego podłoża PDA może pomóc w identyfikacji dzieci z podwyższonym ryzykiem i potencjalnie prowadzić do opracowania bardziej ukierunkowanych strategii profilaktycznych i terapeutycznych.

Podsumowanie i perspektywy na przyszłość

Przetrwały przewód tętniczy pozostaje istotnym problemem klinicznym, szczególnie wśród wcześniaków. Częstość występowania PDA jest odwrotnie proporcjonalna do wieku ciążowego i masy urodzeniowej, z wyraźną przewagą u dziewczynek (stosunek 2:1). Oprócz wcześniactwa, inne czynniki ryzyka obejmują niską masę urodzeniową, zespół zaburzeń oddychania, zakażenie różyczką u matki podczas ciąży oraz zaburzenia genetyczne.¹²³

Diagnostyka PDA opiera się głównie na echokardiografii, która pozwala na ocenę wielkości przewodu i jego hemodynamicznych konsekwencji. Prowadzone są badania nad nowymi metodami ciągłego monitorowania funkcji PDA, które mogłyby poprawić opiekę nad wcześniakami z tą wadą.¹²

W ostatnich latach obserwuje się trend w kierunku bardziej konserwatywnego podejścia do leczenia PDA, szczególnie u klinicznie stabilnych wcześniaków. Podejście to obejmuje obserwację, ograniczenie podaży płynów i stosowanie diuretyków. W przypadkach wymagających interwencji, ibuprofen jest zalecany jako farmakoterapia pierwszego wyboru, a zabieg chirurgiczny lub przezskórny jest rozważany po niepowodzeniu farmakoterapii.¹²³

Wyzwania w nadzorze epidemiologicznym PDA obejmują standaryzację definicji i kryteriów diagnostycznych, ocenę istotności hemodynamicznej oraz różnice w podejściu terapeutycznym. Szersze wykorzystanie i wdrożenie algorytmów PDA mogłoby poprawić wykorzystanie zasobów i standaryzować opiekę nad pacjentami z izolowanym PDA.¹²

Perspektywy na przyszłość obejmują postępy w metodach diagnostycznych, standaryzację opieki, monitorowanie długoterminowych wyników oraz zwiększenie edukacji i świadomości na temat PDA. Zrozumienie genetycznego podłoża PDA może pomóc w identyfikacji dzieci z podwyższonym ryzykiem i potencjalnie prowadzić do opracowania bardziej ukierunkowanych strategii profilaktycznych i terapeutycznych.¹²

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Materiały źródłowe

#1 Patent Ductus Arteriosus: An Overview
https://pmc.ncbi.nlm.nih.gov/articles/PMC3462096/
Patent ductus arteriosus (PDA) is one of the most common congenital heart defects, accounting for 5%10% of all congenital heart disease in term infants. […] The reported incidence of PDA in term neonates is only 1 in 2,000 births, accounting for 5%10% of all congenital heart disease. […] The incidence of PDA in preterm neonates is far greater, with reports ranging from 20%60% (depending on population and diagnostic criteria). […] The increased incidence of PDA in the preterm infant is attributable to the lack of normal closure mechanisms due to immaturity. […] Gestational age and weight are intimately linked to PDA in preterm neonates. […] Approximately 80% of preterm infants presenting with respiratory distress syndrome (RDS) also have a PDA. […] For reasons that have not been elucidated, PDA is more common among female infants than males (2:1). […] Hemodynamically significant PDAs have been associated with significant morbidity and mortality, which can be as high as 30%. […] An understanding of the mechanisms involved, early identification of PDA, and knowledge of therapeutic options are paramount for successful outcomes.
#1 Patent Ductus Arteriosus: Symptoms and Treatment | Doctor
https://patient.info/doctor/patent-ductus-arteriosus
Patent ductus arteriosus (PDA) occurs in 5-10% of all congenital heart defects, excluding premature infants. PDAs are very common in preterm babies and can have significant physiological effects. […] The reported incidence varies widely because of methodological variations in the population studied and definition of PDA. […] In babies born at term the incidence is reported as 1 in 2,000 births which accounts for 5-10% of all congenital heart defects. If children with silent PDA (discovered incidentally by echocardiography done for another purpose) are included, the incidence increases to 1 in 500 births. […] It affects girls twice as often as boys but in congenital rubella syndrome the sex incidence is equal. […] The ductus arteriosus remains patent at day 4 after birth in about 10% of preterm infants born at 30-37 weeks of gestational age, 80% of those born at 25-28 weeks, and 90% of those born at 24 weeks.
#1 Patent Ductus Arteriosus (PDA): Background, Anatomy, Pathophysiology
https://emedicine.medscape.com/article/891096-overview
The estimated incidence of PDA in US children born at term is between 0.02% and 0.006% of live births. This incidence is increased in children who are born prematurely (20% in premature infants 32 weeks’ gestation up to 60% in those 28 weeks’ gestation), children with a history of perinatal asphyxia, and, possibly, children born at high altitude. […] As an isolated lesion, PDA represents 5-10% of all congenital heart lesions. It occurs in approximately 0.008% of live premature births. […] No data support a race predilection. However, there is a female preponderance (female-to-male ratio, 2:1) if the PDA is not associated with other risk factors. In patients in whom the PDA is associated with a specific teratogenic exposure, such as congenital rubella, the incidence is equal between the sexes.
#1 Patent ductus arteriosus epidemiology and demographics – wikidoc
https://www.wikidoc.org/index.php/Patent_ductus_arteriosus_epidemiology_and_demographics
Patent ductus arteriosus epidemiology and demographics On the Web […] The PDA is commonly found in infants and constitutes only 2% of all congenital defects found in adults. The incidence is greater is in children who are born prematurely with history of perinatal asphyxia and infants with congenital rubella. […] In the United States, the estimated incidence in children born at term is between 3 to 8 per 10,000 live births. […] The incidence of patent ductus arteriosus has increased over the past few decades. This is in part due to increased survival in the premature infants. […] The incidence is greater in children who are born: Prematurely, with a history of perinatal asphyxia, perinatal asphyxia delays the closure of the ductus. […] Approximately, 20% of neonates with respiratory distress syndrome have a patent ductus arteriosus. […] In babies who are less than 1500 g at birth, many studies show the incidence of a PDA to exceed 30%. […] Increased incidences in infants with congenital rubella. […] Females are more commonly affected by PDA than males. The female-to-male ratio is approximately 2:1.
#1 Patent ductus arteriosus treatment trends and associated morbidities in neonates | Scientific Reports
https://www.nature.com/articles/s41598-021-89868-z
To evaluate national epidemiologic data on infants treated for patent ductus arteriosus (PDA) in Korea and analyze outcomes associated with different PDA treatments. […] The prevalence of infants with PDA was 81 infants per 10,000 live births and 45.2% in very low birth weight (VLBW) infants, which increased from 2015 to 2018. […] The prevalence of infants diagnosed with PDA was 81 infants per 10,000 live births, and the annual prevalence rate increased from 70 infants per 10,000 live births in 2015 to 94 infants per 10,000 live births in 2018, especially in term infants. […] From National Health Insurance data in Korea, the prevalence of PDA in VLBW infants was 45%, while the prevalence of PDA ligation in VLBW infants was 22%, which was comparable to population studies from the US and Canada.
#1 Patent Ductus Arteriosus (PDA): Symptoms and Treatment
https://my.clevelandclinic.org/health/diseases/17325-patent-ductus-arteriosus-pda
Patent ductus arteriosus is the most common heart condition in newborns. […] Healthcare providers diagnose the condition more often in premature babies. The risk increases the earlier the baby is born. PDA happens in about: 10% of babies born between 30 and 37 weeks of pregnancy. 80% of babies born between 25 and 28 weeks of pregnancy. 90% of babies born earlier than 24 weeks of pregnancy. […] If PDA doesn’t close on its own, healthcare providers can correct it, if needed. Babies and children with moderate and large sized PDAs that are not treated in the correct timeframe may be at higher risk for developing heart complications as adults.
#1 Patent Ductus Arteriosus – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK430758/
A patent ductus arteriosus (PDA) is rare in healthy term newborns. As gestational age decreases, the incidence of PDA increases. In extremely premature infants, especially those with respiratory distress syndrome, up to 80% may have a PDA at 3 days of age. […] The incidence of PDA in premature infants is inversely proportional to gestational age. In infants who are 30 weeks gestation at birth, 90% will have a closed ductus at day 4, and 98% will be closed by the time of discharge. Infants born weighing less than 1000 grams are at the highest risk for PDA. In this population, 70% will have a PDA on day 7. […] In at least 10% of other congenital heart disorders, a patent ductus may be present.
#1 Patent Ductus Arteriosus (PDA) (for Parents) | Nemours KidsHealth
https://kidshealth.org/en/parents/patent-ductus-arteriosus.html
Patent ductus arteriosus (PDA) is more common in premature babies and affects twice as many girls as boys. […] PDA is also common among babies with neonatal respiratory distress syndrome, babies with genetic disorders (such as Down syndrome), and babies whose mothers had rubella (German measles) during pregnancy.
#1 Patent Ductus Arteriosus – TeachMePaediatrics
https://teachmepaediatrics.com/cardiology/congenital-heart-defects/patent-ductus-arteriosus/
PDA is associated with preterm neonates (gestational age 30 weeks) and low birth weight (1000 grams) and accounts for around 5-10% of all congenital heart diseases (CHD), occurring in 1 in 2000 term neonates. […] PDA is twice as common in females (excluding those associated with congenital rubella infection). […] PDA coexists in around 10% of other congenital heart diseases (CHD).
#1 Patent Ductus Arteriosus (PDA) – Pediatrics – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/pediatrics/congenital-cardiovascular-anomalies/patent-ductus-arteriosus-pda
Patent ductus arteriosus accounts for 5 to 10% of congenital heart anomalies; the male:female ratio is 1:3. PDA is very common among preterm infants (present in about 45% with birth weight 1750 g and in 70 to 80% with birth weight 1200 g). […] When persistent in preterm infants, a significant PDA can result in heart failure, exacerbation of lung disease of prematurity, pulmonary hemorrhage, renal insufficiency, feeding intolerance, necrotizing enterocolitis, and even death. […] Diagnosis is suggested by clinical examination, supported by chest x-ray and ECG, and established by 2-dimensional echocardiography with color flow and Doppler studies. […] For preterm infants with hemodynamically significant PDA, give a cyclo-oxygenase (COX) inhibitor (eg, ibuprofen lysine or indomethacin). Surgical or transcatheter closure may benefit patients with a hemodynamically significant PDA in whom medical therapy has failed. […] For full-term infants and older children, COX inhibitors are usually ineffective, but a catheter-delivered occlusion device or surgery typically provides long-term correction of this anomaly.
#1 Management of the patent ductus arteriosus in preterm infants | Canadian Paediatric Society
https://cps.ca/documents/position/patent-ductus-arteriosus
Management of the patent ductus arteriosus (PDA) in preterm infants is one of the most contentious topics in neonatal intensive care. PDAs have been associated without proof of causation with numerous adverse outcomes, including prolongation of assisted ventilation, pulmonary hemorrhage, chronic lung disease (CLD), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), and death. […] Data from the Canadian Neonatal Network suggest an increase in conservative, non-pharmacological management of PDAs in preterm infants in recent years. However, there is no consensus on what conservative management entails and which infants are appropriate candidates. […] Echocardiography should be used to confirm the presence of a left-to-right PDA shunt before considering treatment. […] Clinicians may choose to conservatively manage a PDA in the first 1 to 2 weeks post-birth, especially with clinically stable preterm infants.
#1
https://link.springer.com/article/10.1007/s00431-021-04311-9
Monitoring patent ductus arteriosus (PDA) in premature infants is currently performed intermittently using echocardiography which requires considerable expertise. […] Currently PDA is assessed intermittently using echocardiography which requires considerable expertise and sometimes is not well tolerated by critically ill preterm infants. […] Blood pressure (BP) and ECG waveform interrelation and BP trace time analysis, taking account of heart rate, relate to PDA diameter. […] ECG and BP waveform phase difference as well as BP waveform time analysis may be useful in the continuous assessment of PDA function. […] PDA diameter is generally considered the most useful parameter for determining PDA haemodynamic significance. […] Our study used novel straightforward techniques to measure BP waveform characteristics and interaction between ECG and BP traces in EPIs and relates them with PDA diameter.
#1
https://link.springer.com/article/10.1007/s00431-021-04311-9
Our approach was found to have good repeatability and potentially allows continuous trend monitoring of the PDA diameter. […] Overall the end diastolic time to peak systolic as a proportion of the R-R interval was about 1/3 with longer values being more likely to be associated with larger PDA diameter. […] The present study emphasises the importance of reporting HR and developing methods for correcting for HR when echocardiographic and pulse wave characteristics are used to study changes related to PDA in preterm infants. […] This pilot study has highlighted the importance of HR when assessing physiological variables related to PDA. We observed significant relationships between PDA diameter and BP waveform characteristics normalised for in extremely preterm infants. The phase difference between ECG and BP waveforms as well as BP waveform characteristics are straightforward to implement using routinely monitored waveforms and so potentially could be incorporated in monitors to allow continuous PDA function assessment.
#1 Patent ductus arteriosus treatment trends and associated morbidities in neonates | Scientific Reports
https://www.nature.com/articles/s41598-021-89868-z
The trends in PDA treatment strategy in Korea by year are shown in Figure 2. A conservative approach was increasingly popular from 2015 to 2018 while the use of medication or surgical treatment decreased. […] Our study demonstrated a novel finding that early PDA ligation is superior to PDA ligation after the failure of medical treatment. […] Recent years have shown a trend toward the increased use of conservative management of PDA that has contributed to improved neonatal outcomes in VLBW infants.
#1 Management of the patent ductus arteriosus in preterm infants | Canadian Paediatric Society
https://cps.ca/documents/position/patent-ductus-arteriosus
Ibuprofen should be considered the pharmacotherapy of choice for symptomatic PDA. […] A second course of pharmacotherapy should be considered over invasive management for a persistent, symptomatic PDA if not contraindicated. […] Procedural closure may be considered for infants with persistent PDA even after two courses of pharmacotherapy, or for those with contraindications to pharmacotherapy, especially when their clinical symptoms are significant and echocardiography shows signs of large shunt volume and pulmonary overcirculation. […] Routine referral to a tertiary care centre for echocardiographic evaluation of a persistent PDA in an otherwise clinically stable, growing, preterm infant before term-corrected GA is not recommended.
#1 Clinical Practice Algorithm For the Follow-Up of Unrepaired and Repaired Patent Ductus Arteriosus
https://www.acc.org/Latest-in-Cardiology/Articles/2022/10/31/13/02/Clinical-Practice-Algorithm-For-the-Follow-Up-of-Unrepaired-and-Repaired-PDA
Isolated patent ductus arteriosus (PDA) is a relatively common defect, accounting for 5% to 10% of congenital heart defects (excluding premature infants). […] Given the increased use of echocardiography, incidental detection of asymptomatic „silent” PDA is on the rise. […] There remains a lack of evidence-based guidelines for optimal frequency of follow-up and testing in patients with PDA, either before or following intervention, leading to this wide variation in clinical practice and resource utilization. […] The goal of the PDA clinical practice algorithm is to provide those caring for patients with congenital heart disease (CHD) a decision support tool that can be used prior to and/or following catheterization-based or surgical interventions for PDA. […] The algorithm includes sub-algorithms by age-group (PDA 18 Years of Age, PDA 18 Years of Age) and Post-Intervention.
#1 Patent Ductus Arteriosus: Symptoms and Treatment | Doctor
https://patient.info/doctor/patent-ductus-arteriosus
Therefore, extremely preterm infants born at gestational age of less than 28 weeks are at the highest risk of developing a haemodynamically significant PDA and the related complications. […] PDA is commonly diagnosed in extremely preterm infants and is associated with numerous pathologies, including chronic lung disease (CLD), NEC and intraventricular haemorrhage (IVH).
#1 Surgical management of patent ductus arteriosus in pre-term infants – a british paediatric surveillance study | BMC Pediatrics | Full Text
https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-021-02734-9
The overall mortality rate in our study was 6.5%, with a 30-day mortality rate of 3%. […] This study confirmed there was variation in medical management used prior to referral for PDAL. […] This study should stimulate the neonatal community to consider standardising the medical and surgical management of neonatal PDA.
#1 Surgical management of patent ductus arteriosus in pre-term infants – a british paediatric surveillance study | BMC Pediatrics | Full Text
https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-021-02734-9
This study aimed to provide UK data describing the incidence of patent ductus arteriosus (PDA) surgery in the neonatal population, including: pre-ligation management, and outcomes until discharge. […] Over the study, 263 infants underwent PDAL an incidence of 3.07 per 10,000 live births. […] In 2012 there was limited UK data regarding neonatal PDA ligation (PDAL). […] The study aimed to review UK practice of PDAL in preterm neonates to help inform clinicians which neonates might benefit from PDA ligation; highlighting procedure complications, and post-operative morbidity and mortality. […] There were 856,794 UK livebirth registrations over the study; the incidence of PDAL was 3.07 per 10,000 births. […] Our study again highlights that a higher proportion of extremely preterm males with extremely low birth weight, and ethnically classified as white, require PDAL; correlating with other published series.
#1 Clinical Practice Algorithm For the Follow-Up of Unrepaired and Repaired Patent Ductus Arteriosus
https://www.acc.org/Latest-in-Cardiology/Articles/2022/10/31/13/02/Clinical-Practice-Algorithm-For-the-Follow-Up-of-Unrepaired-and-Repaired-PDA
Frequency of follow-up and testing with echocardiography in the various clinical scenarios is guided by the Appropriate Use Criteria for Multimodality Imaging During the Follow-up Care of Patients with CHD. […] The wide-spread use and implementation of the PDA algorithms could improve resource utilization and standardize care of patients with isolated PDA.
#1 Patent Ductus Arteriosus – Children’s Hospital of Orange County
https://choc.org/heart/congenital-heart-defects/patent-ductus-arteriosus/
The childâs doctor may hear a heart murmur during a physical examination, and refer the child to a pediatric cardiologist for a diagnosis. […] Specific treatment for PDA will be determined by the childâs doctor based on: The childâs age, overall health and medical history, Extent of the PDA, The childâs tolerance for specific medications, procedures or therapies, Expectations for the course of the PDA, The familyâs opinion or preference. […] Although a small patent ductus arteriosus may close spontaneously as a child grows, a PDA that causes symptoms will require medical management, and possibly even surgical repair. […] In premature infants, the outlook after PDA surgical repair depends on the following: The childâs gestational age, Any other illnesses present in the baby. […] 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.
#1 Patent ductus arteriosus (PDA) | UM Health-Sparrow
https://www.uofmhealthsparrow.org/departments-conditions/conditions/patent-ductus-arteriosus-pda
Patent ductus arteriosus (PDA) occurs more commonly in babies who are born too early than in babies who are born full term. […] A family history of heart conditions present at birth may increase the risk of PDA. […] Patent ductus arteriosus can increase the risk of germs attaching to areas in the heart. […] Some heart medicines can be dangerous for an unborn baby. […] There is no known prevention for patent ductus arteriosus. […] To diagnose patent ductus arteriosus (PDA), a healthcare professional does a physical exam and asks questions about you or your child’s medical history. […] Treatments for patent ductus arteriosus (PDA) depend on the age of the person being treated. […] Some people born with PDA need regular health checkups for life, even after treatment to close the opening. […] A large patent ductus arteriosus or one that’s causing serious health concerns may be diagnosed immediately at birth.
#1 Patent ductus arteriosus (PDA) | Bliss
https://www.bliss.org.uk/parents/about-your-baby/medical-conditions/patent-ductus-arteriosus-pda
Although PDAs are more common in babies born premature, they can also occur in babies born at term. […] Your baby is likely to be diagnosed with a PDA on the neonatal unit. […] If your babys doctor suspects that your baby has a PDA, they detect it by using a device that is used to listen to the heart called a stethoscope. […] The treatment that is used to treat the PDA will depend on its size. […] Doctors may monitor the PDA to see if it closes on its own before starting treatment. […] If the ductus arteriosus is large and is left untreated, this can cause pulmonary hypertension (high blood pressure in the lungs). […] Babies who need surgery to close the ductus arteriosus may already have existing conditions that are linked to their prematurity. […] In a survey we conducted of 190 parents, 86% of parents had never heard of or knew little about PDA before their baby had it.
#1 Epidemiology, presentation and population genetics of patent ductus arteriosus (PDA) in the Dutch Stabyhoun dog | BMC Veterinary Research | Full Text
https://bmcvetres.biomedcentral.com/articles/10.1186/s12917-016-0720-x
The population of Stabyhoun dogs, a Dutch hunting breed, is small (approximately 5500 animals worldwide) and seems to be predisposed to PDA. […] In a retrospective study, evaluating PDA in a referral population, the number of presented PDA positive Stabyhoun dogs was approximately 15 times higher than expected. […] The heritability of PDA was 0.51 (0.09) for the reference population and 0.41 (0.10) for the phenotyped population. […] The heritability was calculated using the formula: h2=2 a/(2 a+2 e) where 2 a is the additive genetic variation and 2 a+2 e is the phenotypic variation. […] The heritability of PDA was calculated over the entire reference population, assuming all individuals that did not have a known PDA status were healthy, and over the phenotyped population. Using an animal model the variance components for animal effects were 3.40 for REFPOP and 2.24 for the phenotyped population. The heritability of PDA was 0.51 (0.09) for the reference population and 0.41 (0.10) for the phenotype population. Results of the heritability analysis are summarized in Table 2. In both cases the heritability differed significantly from zero, showing a high hereditary component to PDA in the Stabyhoun dog.
#1 Patent ductus arteriosus (PDA) – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/patent-ductus-arteriosus/symptoms-causes/syc-20376145
Patent ductus arteriosus (PDA) is a persistent opening between the two major blood vessels leading from the heart. […] Patent ductus arteriosus occurs more commonly in babies who are born too early than in babies who are born full term. […] A family history of heart conditions present at birth may increase the risk of PDA. […] Patent ductus arteriosus can increase the risk of germs attaching to areas in the heart.
#1 Patent Ductus Arteriosus (PDA) | Norton Children’s
https://nortonchildrens.com/services/cardiology/conditions/congenital-heart-disease/patent-ductus-arteriosus/
Patent ductus arteriosus is more common in premature babies and affects twice as many girls as boys. It also is common among babies with neonatal respiratory distress syndrome, babies with genetic disorders (such as Down syndrome) and babies whose mothers had rubella (also called German measles) during pregnancy. […] More Louisville and Southern Indiana families choose the board-certified and fellowship-trained specialists at Norton Childrenâs Heart Institute than any other pediatric heart care provider in the area. Treatment is available in Louisville or through a network of diagnostic and treatment services throughout Kentucky and Southern Indiana. […] A surgeon will close a patent ductus arteriosus if the opening is big enough that the lungs are becoming overloaded with blood, a condition that can lead to congestive heart failure and pulmonary hypertension. […] A surgeon also may close the opening to reduce the risk of developing a heart infection called endocarditis, which affects the tissue lining the heart and blood vessels. Endocarditis is serious and requires treatment with intravenous (IV) antibiotics.
#2 Patent Ductus Arteriosus – TeachMePaediatrics
https://teachmepaediatrics.com/cardiology/congenital-heart-defects/patent-ductus-arteriosus/
PDA is associated with preterm neonates (gestational age 30 weeks) and low birth weight (1000 grams) and accounts for around 5-10% of all congenital heart diseases (CHD), occurring in 1 in 2000 term neonates. […] PDA is twice as common in females (excluding those associated with congenital rubella infection). […] PDA coexists in around 10% of other congenital heart diseases (CHD).
#2 Patent ductus arteriosus | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/patent-ductus-arteriosus-pda?embed_domain=hackmd.io%25252f%252540yipuafecsl2jsu8smr5njq%25252fbnjhjgjghjghjgh&lang=gb
Patent ductus arteriosus occurs in ~1 in 2000 full-term neonates with a F: M of 2:1 7,8. […] Patent ductus arteriosus (PDA) is a congenital cardiac anomaly where there is persistent patency of the ductus arteriosus, a normal connection of the fetal circulation between the aorta and the pulmonary arterial system that develops from the 6th aortic arch.
#2 Patent Ductus Arteriosus | Pediatric Echocardiography
https://pedecho.org/library/chd/pda
The incidence of isolated PDA is 1 in 2,000 live births and accounts for 5-10% of all congenital heart disease. However, if silent PDAs (those that produce neither enough shunting for symptoms or an audible murmur) are included the estimation may be as high as 1 in 500. […] There is a 2:1 female to male ratio. A PDA is also more common in premature infants.
#2 Patent Ductus Arteriosus – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK430758/
A patent ductus arteriosus (PDA) is rare in healthy term newborns. As gestational age decreases, the incidence of PDA increases. In extremely premature infants, especially those with respiratory distress syndrome, up to 80% may have a PDA at 3 days of age. […] The incidence of PDA in premature infants is inversely proportional to gestational age. In infants who are 30 weeks gestation at birth, 90% will have a closed ductus at day 4, and 98% will be closed by the time of discharge. Infants born weighing less than 1000 grams are at the highest risk for PDA. In this population, 70% will have a PDA on day 7. […] In at least 10% of other congenital heart disorders, a patent ductus may be present.
#2 Patent Ductus Arteriosus (PDA): Background, Anatomy, Pathophysiology
https://emedicine.medscape.com/article/891096-overview
The estimated incidence of PDA in US children born at term is between 0.02% and 0.006% of live births. This incidence is increased in children who are born prematurely (20% in premature infants 32 weeks’ gestation up to 60% in those 28 weeks’ gestation), children with a history of perinatal asphyxia, and, possibly, children born at high altitude. […] As an isolated lesion, PDA represents 5-10% of all congenital heart lesions. It occurs in approximately 0.008% of live premature births. […] No data support a race predilection. However, there is a female preponderance (female-to-male ratio, 2:1) if the PDA is not associated with other risk factors. In patients in whom the PDA is associated with a specific teratogenic exposure, such as congenital rubella, the incidence is equal between the sexes.
#2 Patent ductus arteriosus (PDA) – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/patent-ductus-arteriosus/symptoms-causes/syc-20376145
Patent ductus arteriosus (PDA) is a persistent opening between the two major blood vessels leading from the heart. […] Patent ductus arteriosus occurs more commonly in babies who are born too early than in babies who are born full term. […] A family history of heart conditions present at birth may increase the risk of PDA. […] Patent ductus arteriosus can increase the risk of germs attaching to areas in the heart.
#2 Management of the patent ductus arteriosus in preterm infants | Canadian Paediatric Society
https://cps.ca/documents/position/patent-ductus-arteriosus
Management of the patent ductus arteriosus (PDA) in preterm infants is one of the most contentious topics in neonatal intensive care. PDAs have been associated without proof of causation with numerous adverse outcomes, including prolongation of assisted ventilation, pulmonary hemorrhage, chronic lung disease (CLD), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), and death. […] Data from the Canadian Neonatal Network suggest an increase in conservative, non-pharmacological management of PDAs in preterm infants in recent years. However, there is no consensus on what conservative management entails and which infants are appropriate candidates. […] Echocardiography should be used to confirm the presence of a left-to-right PDA shunt before considering treatment. […] Clinicians may choose to conservatively manage a PDA in the first 1 to 2 weeks post-birth, especially with clinically stable preterm infants.
#2
https://link.springer.com/article/10.1007/s00431-021-04311-9
Our approach was found to have good repeatability and potentially allows continuous trend monitoring of the PDA diameter. […] Overall the end diastolic time to peak systolic as a proportion of the R-R interval was about 1/3 with longer values being more likely to be associated with larger PDA diameter. […] The present study emphasises the importance of reporting HR and developing methods for correcting for HR when echocardiographic and pulse wave characteristics are used to study changes related to PDA in preterm infants. […] This pilot study has highlighted the importance of HR when assessing physiological variables related to PDA. We observed significant relationships between PDA diameter and BP waveform characteristics normalised for in extremely preterm infants. The phase difference between ECG and BP waveforms as well as BP waveform characteristics are straightforward to implement using routinely monitored waveforms and so potentially could be incorporated in monitors to allow continuous PDA function assessment.
#2 Patent ductus arteriosus (PDA) | Great Ormond Street Hospital
https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/patent-ductus-arteriosus-pda/
In some babies, especially in those born prematurely, this vessel may remain open. This is called a patent or persistent ductus arteriosus. […] A patent ductus arteriosus increases the blood flow to the lungs. This can make it harder for the baby to breathe and come off the ventilator. […] Many babies with a PDA will have been kept on reduced fluid intake and given diuretic medicines to try to treat fluid overload caused by heart failure. […] The team looking after the baby may have suspected a PDA as the baby had difficulty coming off the ventilator or CPAP machine. The baby will then have had an echocardiogram to confirm the diagnosis. […] Echocardiograms and sometimes X-rays will be done the same day and/or the next day to confirm good position of the device and closure of the PDA. […] Your baby will then be followed up in the neonatal unit and later in outpatient clinic at regular intervals thereafter.
#2 Patent Ductus Arteriosus: Symptoms and Treatment | Doctor
https://patient.info/doctor/patent-ductus-arteriosus
Therefore, extremely preterm infants born at gestational age of less than 28 weeks are at the highest risk of developing a haemodynamically significant PDA and the related complications. […] PDA is commonly diagnosed in extremely preterm infants and is associated with numerous pathologies, including chronic lung disease (CLD), NEC and intraventricular haemorrhage (IVH).
#2 Patent Ductus Arteriosus – Children’s Hospital of Orange County
https://choc.org/heart/congenital-heart-defects/patent-ductus-arteriosus/
The childâs doctor may hear a heart murmur during a physical examination, and refer the child to a pediatric cardiologist for a diagnosis. […] Specific treatment for PDA will be determined by the childâs doctor based on: The childâs age, overall health and medical history, Extent of the PDA, The childâs tolerance for specific medications, procedures or therapies, Expectations for the course of the PDA, The familyâs opinion or preference. […] Although a small patent ductus arteriosus may close spontaneously as a child grows, a PDA that causes symptoms will require medical management, and possibly even surgical repair. […] In premature infants, the outlook after PDA surgical repair depends on the following: The childâs gestational age, Any other illnesses present in the baby. […] 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.
#2 Patent Ductus Arteriosus | UCSF Department of Surgery
https://surgery.ucsf.edu/condition/patent-ductus-arteriosus
Patent ductus arteriosus (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). […] PDA is twice as common in girls as it is in boys. […] PDA is a relatively common congenital heart defect in the United States. On average, PDA occurs in about 2 of every 1,000 full-term births and about 8 of every 1,000 premature births. […] The condition also is more common in infants who have genetic conditions (such as Down syndrome) and infants whose mothers had German measles (rubella) during pregnancy. […] A heart murmur (an extra or unusual sound heard during the heartbeat) may be the only sign that a baby or child has PDA.
#2 Management of the patent ductus arteriosus in preterm infants | Canadian Paediatric Society
https://cps.ca/documents/position/patent-ductus-arteriosus
Ibuprofen should be considered the pharmacotherapy of choice for symptomatic PDA. […] A second course of pharmacotherapy should be considered over invasive management for a persistent, symptomatic PDA if not contraindicated. […] Procedural closure may be considered for infants with persistent PDA even after two courses of pharmacotherapy, or for those with contraindications to pharmacotherapy, especially when their clinical symptoms are significant and echocardiography shows signs of large shunt volume and pulmonary overcirculation. […] Routine referral to a tertiary care centre for echocardiographic evaluation of a persistent PDA in an otherwise clinically stable, growing, preterm infant before term-corrected GA is not recommended.
#2 Clinical Practice Algorithm For the Follow-Up of Unrepaired and Repaired Patent Ductus Arteriosus
https://www.acc.org/Latest-in-Cardiology/Articles/2022/10/31/13/02/Clinical-Practice-Algorithm-For-the-Follow-Up-of-Unrepaired-and-Repaired-PDA
Frequency of follow-up and testing with echocardiography in the various clinical scenarios is guided by the Appropriate Use Criteria for Multimodality Imaging During the Follow-up Care of Patients with CHD. […] The wide-spread use and implementation of the PDA algorithms could improve resource utilization and standardize care of patients with isolated PDA.
#3 Patent Ductus Arteriosus | 5-Minute Pediatric Consult
https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617572/all/Patent_Ductus_Arteriosus
Patent ductus arteriosus (PDA) is the persistence into postnatal life of the normal fetal vascular conduit between the central pulmonary and systemic arterial systems. Normally, the ductus arteriosus (DA) functionally closes within the first 1 to 3 days of life. Structural closure is usually completed by the 3rd week of life. If the DA remains patent beyond 3 months of life, it is considered abnormal and is unlikely to close spontaneously (spontaneous closure rate 0.6% per year). […] As an isolated defect, PDA is the 6th most common congenital cardiovascular lesion. […] Represents 5% of all types of CHD […] 1 per 2,000 live births […] If silent PDA are included, the rate may be as high as 1:500 live births. […] Female-to-male ratio: 2:1.
#3 Patent Ductus Arteriosus: Symptoms and Treatment | Doctor
https://patient.info/doctor/patent-ductus-arteriosus
Patent ductus arteriosus (PDA) occurs in 5-10% of all congenital heart defects, excluding premature infants. PDAs are very common in preterm babies and can have significant physiological effects. […] The reported incidence varies widely because of methodological variations in the population studied and definition of PDA. […] In babies born at term the incidence is reported as 1 in 2,000 births which accounts for 5-10% of all congenital heart defects. If children with silent PDA (discovered incidentally by echocardiography done for another purpose) are included, the incidence increases to 1 in 500 births. […] It affects girls twice as often as boys but in congenital rubella syndrome the sex incidence is equal. […] The ductus arteriosus remains patent at day 4 after birth in about 10% of preterm infants born at 30-37 weeks of gestational age, 80% of those born at 25-28 weeks, and 90% of those born at 24 weeks.
#3 Patent ductus arteriosus – Wikipedia
https://en.wikipedia.org/wiki/Patent_ductus_arteriosus
In full-term newborns, PDA occurs in 1 in 2,000 births, and accounts for 510% of congenital heart disease cases. PDA occurs in 2060% of all premature newborns, where its incidence is inversely linked with gestational age and weight. […] Some evidence suggests that intravenous NSAIDs, such as indomethacin, administration on the first day of life to all preterm infants reduces the risk of developing a PDA and the complications associated with PDA. […] While indometacin can be used to close a PDA, some neonates require their PDA be kept open. Keeping a ductus arteriosus patent is indicated in neonates born with concurrent heart malformations, such as transposition of the great vessels.
#3 Patent Ductus Arteriosus (PDA)
https://healthlibrary.osfhealthcare.org/Library/DiseasesConditions/Adult/Kidney/90,P01811
Patent ductus arteriosus (PDA) is a heart defect found in the days or weeks after birth. […] PDA occurs twice as often in girls as in boys. […] PDA happens most often in premature infants. It often occurs with other congenital heart defects. […] An infant or child with PDA will be cared for by a pediatric cardiologist. […] Most children with a fixed PDA will live normal, healthy lives.
#3 Patent Ductus Arteriosus (PDA) | Norton Children’s
https://nortonchildrens.com/services/cardiology/conditions/congenital-heart-disease/patent-ductus-arteriosus/
Patent ductus arteriosus is more common in premature babies and affects twice as many girls as boys. It also is common among babies with neonatal respiratory distress syndrome, babies with genetic disorders (such as Down syndrome) and babies whose mothers had rubella (also called German measles) during pregnancy. […] More Louisville and Southern Indiana families choose the board-certified and fellowship-trained specialists at Norton Childrenâs Heart Institute than any other pediatric heart care provider in the area. Treatment is available in Louisville or through a network of diagnostic and treatment services throughout Kentucky and Southern Indiana. […] A surgeon will close a patent ductus arteriosus if the opening is big enough that the lungs are becoming overloaded with blood, a condition that can lead to congestive heart failure and pulmonary hypertension. […] A surgeon also may close the opening to reduce the risk of developing a heart infection called endocarditis, which affects the tissue lining the heart and blood vessels. Endocarditis is serious and requires treatment with intravenous (IV) antibiotics.
#3
https://pted.org/?id=patentductus4
Large PDAs are rarely discovered in the adult patient. […] Diagnosis of a small PDA is often difficult because of the lack of major symptoms. […] The PDA is best observed and evaluated through echocardiography, producing an echocardiogram, which will allow the physician to study its size and effects. […] If a significant PDA is found to exist, closure may be necessary in order to stop the left to right shunting of blood. […] After the PDA has been closed, medical follow-up is unnecessary in the absence of other symptoms.
#3 Patent ductus arteriosus treatment trends and associated morbidities in neonates | Scientific Reports
https://www.nature.com/articles/s41598-021-89868-z
The trends in PDA treatment strategy in Korea by year are shown in Figure 2. A conservative approach was increasingly popular from 2015 to 2018 while the use of medication or surgical treatment decreased. […] Our study demonstrated a novel finding that early PDA ligation is superior to PDA ligation after the failure of medical treatment. […] Recent years have shown a trend toward the increased use of conservative management of PDA that has contributed to improved neonatal outcomes in VLBW infants.
#4 Pediatric patent ductus arteriosus (PDA) â Childrenâs Health Cardiology
https://www.childrens.com/specialties-services/conditions/patent-ductus-arteriosus
#5 Patent ductus arteriosusÂ (PDA) | EBSCO Research Starters
https://www.ebsco.com/research-starters/health-and-medicine/patent-ductus-arteriosus-pda
Patent ductus arteriosus (PDA) is more prevalent in premature infants and is particularly common among those with certain genetic disorders or maternal infections during pregnancy, such as rubella. […] PDA is more common in girls than boys, specifically in premature infants and especially in those with neonatal respiratory distress syndrome. […] Infants whose mothers had rubella (German measles) during pregnancy are at a high risk for the condition. […] Although some infants are at a higher risk than others for developing the condition, the exact cause of PDA is not known. […] Infants born at altitudes higher than 10,000 feet (3,048 meters) are at a higher risk of developing PDA than infants born at lower altitudes. […] Women who have PDA and get pregnant may face serious issues during pregnancy. They are at a higher risk for certain complications such as arrhythmia (abnormal heartbeat), heart failure, and pulmonary hypertension.