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Key Features

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  • Hyperdynamic precordium

  • Widened pulse pressure

  • Hypotension

  • Presence of a systolic heart murmur in many cases

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Clinical Findings

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  • Signs include a hyperdynamic precordium, increased peripheral pulses, and a widened pulse pressure with or without a systolic machinery type heart murmur

  • Early presentations are sometimes manifested by systemic hypotension without a murmur or hyperdynamic circulation

  • These signs are often accompanied by an increased need for respiratory support and metabolic acidemia

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Diagnosis

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  • Echocardiogram confirms diagnosis

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Treatment

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  • Medical or surgical ligation

  • Indomethacin

    • Dosage: 0.2 mg/kg intravenously every 12 hours for three doses

    • Can close clinically significant ductus in about two-thirds of cases

    • If the ductus reopens or fails to close completely, a second course of drug may be used or surgical ligation can be considered if the infant remains symptomatic

    • Can be used prophylactically

      • In the extremely low-birth-weight infant (< 1000 g) who is at very high risk for developing a symptomatic ductus

      • Dosage: 0.1 mg/kg every 24 hours for 3–5 days beginning on the first day of life

  • Ibuprofen lysine

    • Can be used as an alternative to indomethacin

    • Dosage: every 24 hours as an initial dose of 10 mg/kg and then 5 mg/kg for two doses

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