Pediatric patent ductus arteriosus (PDA)

What is pediatric patent ductus arteriosus (PDA)?

Before birth, babies have a connection (the ductus arteriosus) between the two main blood vessels in their heart. In the womb, babies receive oxygen-rich blood from their mother’s placenta, so blood doesn’t need to go to the lungs to pick up oxygen. The ductus arteriosus allows oxygen-poor blood to go to the placenta, bypassing the lungs.

Shortly after birth, this connection should close. If not, it’s called a patent ductus arteriosus (PDA). After birth, a large PDA can allow oxygen-rich blood flow back into the lungs instead of out to the body. The excess blood flow forces your child’s heart and lungs to work harder, which can damage them.

What are the signs and symptoms of pediatric patent ductus arteriosus (PDA)?

• Poor feeding, which leads to poor growth

• Sweating with crying or eating

• Rapid breathing or difficulty breathing

• Easy tiring

• Rapid heart rate

• Recurrent lung infections

Children with a small PDA may not have symptoms, or symptoms might develop later, even in adulthood. Large PDAs can cause signs and symptoms soon after birth.

The symptoms of patent ductus arteriosus (PDA) may look like those in other, less serious conditions. If you notice any of these signs or symptoms in your child, contact your child’s pediatrician who can decide if more testing is necessary.

How is pediatric patent ductus arteriosus (PDA) diagnosed?

Doctors often diagnose PDA in premature infants while they are in the neonatal intensive care unit (NICU). A small number of full-term infants may go home and be diagnosed later after experiencing symptoms.

Your child’s pediatrician will start with a comprehensive physical exam that includes:

• Asking questions about growth, development, family history and any recent illnesses

• Listening to the heart and lungs

• Observing symptoms

If the pediatrician suspects that your child might have PDA or other heart problems, they may refer your child to a pediatric cardiologist for further testing. At Children’s Health, our pediatric cardiologists specialize in recognizing the signs of heart conditions, such as a PDA, that affect children. We offer comprehensive testing to uncover the causes of your child’s symptoms and plan the right treatment for them. Learn more about our cardiac imaging.

To confirm a diagnosis of a patent ductus arteriosus, your child may need tests including:

• Echocardiogram (echo) - This noninvasive ultrasound of your child’s heart shows the structure of your child’s heart and blood flow through it. We use echo to see the size of the PDA and how well your child’s heart is working.

• Electrocardiogram (EKG or ECG) - An EKG records electrical activity in your child’s heart, which controls heart rate and rhythm. Our cardiologists use EKGs to see if the heart is enlarged and check for heart rhythm problems.

What causes pediatric patent ductus arteriosus (PDA)?

In most cases doctors don’t know exactly why a PDA does not close. It’s more common in premature infants, but not all premature infants develop a PDA. In some patients, the PDA is genetic or a part of a syndrome.

How is pediatric patent ductus arteriosus (PDA) treated?

Treatment for patent ductus arteriosus varies depending on the size, the amount of the blood flow and your child’s size. Your child’s care team includes neonatologists (doctors who specialize in newborn care), pediatric cardiologists, pediatric interventional cardiologists and pediatric heart surgeons. The team works closely with you to decide on their right treatment for your child.

Our advanced care includes:

• Heart (cardiothoracic) surgery - Catheterization may not be possible if due to the size of the PDA or in very small premature infants. They may need open surgery instead. At Children’s Health, our pediatric heart surgeons use a minimally invasive approach with tiny incisions to close the PDA. Your child’s heart care team will guide you through this process.In addition to these treatments, premature babies and babies with a large PDA need special, high-calorie formula. This formula helps babies who have difficulty feeding gain weight and grow properly.

• 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 child’s leg to insert a catheter (thin tube with miniaturized instruments). They then guide the catheter through your child’s blood vessels and heart chambers and into the PDA. Surgeons can close the PDA with a plug.