Patent Ductus Arteriosus

Key Features

• Hyperdynamic precordium

• Widened pulse pressure

• Hypotension

• Presence of a systolic heart murmur in many cases

Clinical Findings

• 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

Diagnosis

• Echocardiogram confirms diagnosis

Treatment

• 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