Closing the PDA

Many preemies often face an issue with their Patent Ductus Arteriosus (PDA).

The PDA is a blood vessel that connects the main vessel leading to the lungs to the main vessel of the body. When babies are in the womb, this blood vessel is open because babies aren't using their lungs to breathe so it allows most of the blood to bypass the lungs and go to the rest of the body. Once babies are born, the blood vessel will gradually narrow and then close after a few hours or days. In preemies, especially those who have had respiratory distress syndrome, the blood vessel may stay open.

Doctors may suspect that a preemie has a PDA if a preemie:

• needs more oxygen or help breathing when s/he should be needing less
• his/her breathing is more difficult or there is much more apnea
• the doctor or nurse hears a murmur (an abnormal noise over the heart)
• the baby's heart rate increases and/or the pulse changes

If a doctor suspects a PDA, they will give your preemie an echocardiogram to determine the amount of blood flow through the PDA. The echocardiagram is pretty fast - it looks like your baby is getting an ultrasound.

The doctors have several options for how to treat a PDA. They are:

• Wait. If the PDA is very small with only a tiny amount of blood flowing through it, doctors may decide to wait and see if it closes on its own.
• Medicine. Indomethacin is the most common drug used to try and close a PDA. It can affect some of your preemie's other organs so they use the smallest dose possible. Some doctors use ibuprofen.
• Surgery. If the PDA doesn't close with medicine (or on its own), then they will need to do surgery to close the PDA.

Hearing that your baby needs heart surgery can be very scary and nerve wracking. Here are some questions to ask if your preemie needs surgery:

• What are the potential complications? Some preemies have had their vocal cord affected by this surgery.
• How long does it typically take? It's always nice to know how long a surgery is supposed to last however there may always be extra time if something is delayed. Ask if a nurse or someone else can come and tell you if there is a delay so you aren't worried unnecessarily.
• Where do they do the surgery? Some NICUs are equipped to have the surgery done at your baby's isolette. Others require the baby to be transferred to another hospital.
• What do they do during the surgery? Ask the cardiac specialist to explain the procedure to you so that you understand what is being done
• What are the long term effects, if any?

Our experience with PDA issues
Both of our kids had PDAs. We were told our son would need surgery because he was only able to handle 1/2 dose of the indomethacin and the PDA was still open. After spending a long night worrying about the next day's transfer and surgery - we went to the NICU the next morning and after one last echo, they found that the PDA had closed on it's own. The doctors aren't sure how it happened but we were so happy and relieved. With our daughter, they came in to my hospital room on her 2nd day and told us that her PDA was very open and she was too small to receive the indomethacin so surgery was a necessity. She was the smallest patient that our heart surgeon had operated on so that added a bit of extra stress. Thankfully all went well and with the exception of a scar on her back, you would never know she had it done.