Pediatrics · Topic 24 of 42
Patent Ductus Arteriosus (PDA)
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Patent Ductus Arteriosus (PDA)
The fetal ductus arteriosus fails to close after birth, most often in preterm infants. The drugs that close it can hurt the kidneys, platelets and gut.
Why it happens
The fetal ductus arteriosus fails to close after birth
Rising oxygen and falling prostaglandin levels normally begin closing the ductus within the first 10–15 hours of life; the fetal shunts are taught in Fetal Circulation.
Who gets it
Prematurity — the lower the birth weight, the higher the risk
A PDA is present in about 45% of infants under 1,750 g and 70–80% of infants under 1,200 g; about one third close on their own.
What you'll see
A machinery murmur under the left clavicle with bounding pulses
Labs & monitoring
Before every closing dose: urine output
Red flags
Treatment
IV indomethacin or ibuprofen closes the PDA
Check urine output before each doseIV acetaminophen is an alternative closing drug
Catheter device or surgical ligation closes the PDA
Care as for any infant in heart failure
Who can't get drug closure, term infants, and untreated PDA
Nursing priorities
Close the duct or keep it open?
Prostaglandin inhibitors close it · prostaglandin E1 keeps it open
| Close a PDA | Keep the duct open | |
|---|---|---|
| Drug | Indomethacin or ibuprofen IV (prostaglandin inhibitors) | Alprostadil (prostaglandin E1) |
| Who gets it | Preterm infant with a PDA | Duct-dependent defect — transposition, critical coarctation |
| Biggest danger | Low urine output, bleeding, NEC | Apnea (boxed warning), in about 10–12% of neonates |
| Nurse does | Check urine output before each dose | Continuous cardiorespiratory monitoring, ventilation ready |
Teach the family
Indomethacin or ibuprofen closes a PDA; alprostadil keeps the duct open. Machinery murmur + bounding pulses in a preterm infant = PDA. Check urine output before every closing dose.
Sources · Patent Ductus Arteriosus (Merck Manual Professional) · Patent ductus arteriosus (MedlinePlus) · Indomethacin for Injection label (DailyMed) · NeoProfen (ibuprofen lysine) label (DailyMed) · Prostin VR Pediatric (alprostadil) label (DailyMed) · Paracetamol for PDA in preterm infants (Cochrane) · Antibiotic Prophylaxis Prior to Dental Procedures (ADA) · Follow your facility's protocol for indomethacin and ibuprofen dosing.
Patent Ductus Arteriosus (PDA)
Patent ductus arteriosus (PDA) is a heart defect in which the ductus arteriosus, the fetal vessel joining the aorta and the pulmonary artery, fails to close after birth, and it is most common in preterm infants. After birth the shunt runs left to right, from the aorta into the pulmonary artery, so extra blood floods the lungs while the infant stays pink. The nurse listens for a continuous machinery murmur at the left upper sternal border under the left clavicle and feels for bounding pulses with a widened pulse pressure. In a preterm infant, worsening respiratory distress, apnea and rising ventilator needs signal a significant PDA. IV indomethacin or ibuprofen closes the duct in preterm infants, and IV acetaminophen is an alternative. Because these drugs reduce kidney blood flow and platelet function, the nurse checks urine output before every dose and holds it if output is under 0.6 mL/kg/hr, monitors creatinine and platelets, and watches for bleeding and necrotizing enterocolitis. The contrast is high yield: alprostadil keeps the ductus open in duct-dependent defects, and its boxed warning is apnea.
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