A condition often seen in the NICU is a PDA, patent ductus arteriosus. This heart defect can be a source of concern for new parents and a key focus of care for nurses and doctors but can also be of little concern. In this blog post, I aim to shed light on what PDA is, how it’s typically treated, and what parents can expect if their baby is diagnosed with this condition.
What is a PDA?
The ductus arteriosus is a normal fetal blood vessel that connects the pulmonary artery to the aorta, allowing blood to bypass the lungs in utero. After birth, this vessel usually closes as the newborn begins to breathe air, and the circulatory system shifts to accommodate oxygen exchange in the lungs. However, when the ductus arteriosus fails to close as it should, we see a Patent Ductus Arteriosus, or PDA.
In simple terms, PDA is an open blood vessel that should have closed but remains open, allowing oxygen-rich blood from the aorta to mix with oxygen-poor blood from the pulmonary artery. This can put strain on the heart and increase blood flow to the lungs, potentially leading to respiratory and cardiac complications.
How is a PDA Diagnosed?
A PDA is often detected through a combination of clinical signs and diagnostic tests. Nurses and doctors may notice a heart murmur, which is an unusual sound heard while listening to a heartbeat. Symptoms can vary but may include difficulty breathing evidenced by increase work of breathing or brady/desats, poor feeding, and slow growth. In the NICU, we frequently use echocardiograms (ultrasound of the heart) to confirm the diagnosis and assess the size and impact of the PDA.
Treatment Options for PDA
The treatment of the PDA depends on the size of the defect, the age and health of the baby, and the severity of symptoms. Here are some common approaches:
- Watchful Waiting: In some cases, especially if the PDA is small and not causing significant symptoms, doctors may opt for a conservative approach. Many PDAs close on their own without intervention, particularly in preterm infants as they grow and mature.
- Medications: For babies with symptomatic PDA or those where spontaneous closure is unlikely, medications such as ibuprofen or Tylenol may be used. These drugs can help stimulate the closure of the ductus arteriosus by inhibiting prostaglandins, which keep the vessel open.
- Surgical Intervention: If medication is ineffective or the PDA is causing severe symptoms, surgical closure may be necessary. This can be done through a catheter-based procedure called transcatheter device closure, which is relatively routine & has an easy recovery in most cases.
- Supportive Care: Alongside these treatments, supportive care is crucial. This may include supplemental oxygen, fluid management, and monitoring for potential complications such as heart failure or pulmonary hypertension.
What Can Parents Expect?
For parents, hearing that their baby has a heart condition can be overwhelming. In the NICU, we strive to provide clear communication and compassionate care to help families navigate this challenging time. It’s important to remember that many babies with PDA do well with treatment and go on to lead healthy lives. We encourage parents to ask questions and be involved in their baby’s care, as understanding the condition and treatment options can provide a sense of control and reassurance.
Conclusion: A Team Effort
Managing a PDA in the NICU requires a collaborative effort between nurses, doctors, and families. As NICU nurses, we play a vital role in monitoring the baby’s condition, administering treatments, and providing emotional support to parents. By staying informed and working together, we can ensure the best possible outcomes for these tiny patients.
For new parents, know that you’re not alone in this journey. The NICU team is here to support you and your baby every step of the way.
