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Premature Baby-Patent ductus art

Premature Baby-Patent ductus arteriosus (PDA)

 

It is an abnormal opening between two major blood vessels, the aorta and the pulmonary artery. Fortunately, this congenital heart defect often closes on its own or is readily treatable.

Patent ductus arteriosus is common in premature babies, but rare in infants born at full term. As a baby develops in the womb, an opening (duct) between the aorta and pulmonary artery is a normal and necessary part of fetal circulation. But, this duct is supposed close within two or three days after birth once the newborn's heart adapts to life outside the womb. In premature babies, the defect often closes on its own within a few weeks of birth.

A small patent ductus arteriosus often doesn't cause symptoms. A doctor may discover it by chance during a routine exam. An infant with a larger opening often has trouble gaining weight, may become short of breath and may sweat when crying or playing. An older child with patent ductus arteriosus may not be as active as normal, may tire more easily and may have frequent lung infections.

Treatment options for repairing a patent ductus arteriosus include medications and surgery. Once repaired, this defect won't affect a child's growth or development and rarely causes long-term problems.

Signs and symptoms

Signs and symptoms of a patent ductus arteriosus vary with the size of the defect and the gestational age of the infant at birth. A small defect may cause no signs or symptoms, and may go undetected for some time. A larger one can cause signs of heart failure soon after birth. A premature baby may have other problems related to prematurity and related testing may uncover a heart defect.

Your doctor may first suspect a heart defect during a regular checkup while listening to your premature baby's heart through a stethoscope.

A large patent ductus arteriosus may cause:

  • Poor eating, poor growth

  • Sweating with crying or play

  • Persistent fast breathing or breathlessness

  • Easy tiring

  • Rapid heart rate

  • Frequent lung infections

Causes

Congenital heart defects arise from errors early in the heart's development — but there's often no clear cause. Genetics and perhaps environmental factors may play a role.A patent ductus arteriosus occurs when the connection between the pulmonary artery and the aorta fails to close soon after birth. The abnormal opening causes too much blood to circulate to the lungs and heart. If not treated, the blood pressure in the lungs may increase (pulmonary hypertension) and the heart may weaken.

 

Risk factors

Congenital heart defects appear to run in families and sometimes occur with other genetic problems, such as Down syndrome. If you have a premature baby with a congenital heart defect, a genetic counselor can predict the approximate odds that any future children could have one.

Experiencing any the following conditions during pregnancy can increase your risk of having a baby with a heart defect.

  • Rubella infection. Becoming infected with rubella (German measles) while pregnant can increase the risk of fetal heart defects. The rubella virus crosses the placenta and spreads through the fetus's circulatory system damaging blood vessels and organs, including the heart.

  • Poorly controlled diabetes. Uncontrolled diabetes in the mother in turn affects the fetus's blood sugar causing various damaging effects to the developing fetus.

  • Drug or alcohol use or exposure to certain substances. Use of certain medications, alcohol or drugs, or exposure to chemicals or radiation during pregnancy can harm the developing fetus.

When to seek medical advice

Call your doctor if your infant or child:

  • Tires easily when eating or playing

  • Is not gaining weight

  • Becomes breathless when eating or crying

  • Always breathes rapidly or is short of breath

  • Turns dusky or blue when crying or eating

Screening and diagnosis

Your premature baby's doctor may detect a heart defect when listening to his or her heart. Patent ductus arteriosus can cause a heart murmur that your doctor can hear through a stethoscope. If your doctor hears a heart murmur or finds other signs or symptoms of a heart defect, he or she may request one or more of these tests:

  • Echocardiogram. An echocardiogram uses sound waves to produce a video image of the heart. This image can help doctors see the heart chambers and evaluate how well the heart is pumping. This test also checks the heart valves and looks for any other heart defects.

  • Chest X-ray. An X-ray image helps the doctor see the condition of your baby's heart and lungs and the amount of blood in the lungs. An X-ray may identify conditions other than a heart defect that may explain your premature baby's symptoms.

  • Electrocardiogram (ECG or EKG). This test records the electrical activity of your premature baby's heart through patches attached to the skin. This test helps diagnose heart defects or rhythm problems.

  • Cardiac catheterization. In this test, a thin, flexible tube (catheter) is inserted into a blood vessel at your premature baby's groin or arm and guided through it into the heart. Through catheterization, doctors can do further testing to evaluate congenital heart defects found during echocardiography. In certain defects, treatment procedures can be done during cardiac catheterization to improve the heart's function.

Occasionally, a small patent ductus arteriosus may not be detected until adulthood.

Complications

A small patent ductus arteriosus may not cause symptoms. Larger defects that are untreated can cause high blood pressure in the lungs (pulmonary hypertension), frequent lung infections or heart failure, a chronic condition in which the heart can't pump effectively.

A premature baby with an unrepaired patent ductus arteriosus is at risk for a blood vessel infection. For this reason, children and adults with patent ductus arteriosus take antibiotics before procedures such as dental work.

A premature baby who has surgery or catheterization to close the ductus needs will need to take antibiotics before dental or other procedures for at least six months after the procedure.

Treatment

In a premature baby, the patent ductus arteriosus often closes on its own in the weeks after birth. In a full term infant, a patent ductus arteriosus usually will close within the first few days of life. If the defect doesn't close and it causes breathing or growth problems, surgery may be needed to close it.

Medications
Doctors use nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or indomethacin, to help close a patent ductus arteriosus in premature babies. NSAIDs block the hormone-like chemicals in the body that keep the PDA open.

Surgery
Surgery to repair a patent ductus arteriosus involves patching or sewing shut the abnormal opening. This can be done through an incision in the side of the chest or by catheterization. In cardiac catheterization, a thin tube (catheter) is inserted into a blood vessel in the groin and threaded up to the heart. Through the catheter, a small plug or coil may be deployed to close the ductus arteriosus. In surgery, the ductus is closed with a metal clip.

Prevention

In most cases, you can't do anything to prevent having a baby with a heart defect. However, it's important to do everything possible to have a healthy pregnancy. Here are the basics:

  • Get early prenatal care, even before you're pregnant. Quitting smoking, reducing stress, stopping birth control — these are all things to talk to your doctor about before you get pregnant. Also, be sure you talk to your doctor about any medications you are taking.

  • Eat a well-balanced diet. Include a vitamin supplement that contains folic acid. Also, limit caffeine.

  • Exercise regularly. Work with your doctor to develop an exercise plan that's right for you.

  • Avoid risks. These include harmful substances such as alcohol, cigarettes and illicit drugs. Also, avoid X-rays, hot tubs and saunas.

  • Avoid infections. Be sure you are up-to-date on all of your vaccinations before becoming pregnant. Certain types of infections can be harmful to a developing fetus.

  • Keep diabetes under control. If you have diabetes, work with your doctor to be sure its well controlled before and after getting pregnant.

If you have a family history of heart defects or other genetic disorders, consider talking with a genetic counselor before getting pregnant.

Self-care

If your child has a congenital heart defect, or has had surgery to correct one, you may have some concerns about whether he or she can safely play, go to school and fit in with other kids.

  • Preventing infection. A child who has a patent ductus arteriosus will need to take antibiotics before most dental or surgical procedures to prevent infection. Heart defects, and the repair of defects, create changes to the surface of the heart muscle in which bacteria can get stuck and grow into an infection called endocarditis.

  • Exercising and play. Children with small defects or a repaired hole in the heart will usually have few or no related restrictions on activity or exercise.

  • Pregnancy. Pregnancy is often a concern for women born with a heart defect. Most women with a small or repaired patent ductus arteriosus, or who don't have symptoms, can tolerate pregnancy without any problems. However, complications, such as heart failure or Eisenmenger's syndrome, can increase your risk of problems during pregnancy. Doctors strongly advise women with Eisenmenger's syndrome not to become pregnant. If you have a congenital heart defect, repaired or not, and you're considering pregnancy, carefully discuss it beforehand with your cardiologist.

by Mayo Clinic Staff

 

 

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