Pda

Front 1

At birth, what is happening with the PDA?

Back 1

The ductus arteriosus is patent in all newborns at the time of delivery.

Front 2

When do PDA normally closes?

Back 2

1.>40 wk gestation - 100% closes by 48 hr after birth.
2.>30 wk gestation - 90% closes by 72 hr after birth.

Front 3

When do you consider persistent PDA ?

Back 3

When a ductus is open beyound 72 hr after birth (3 days)

Front 4

Who is at increased risk for persistent PDA?

Back 4

Preterm infants

Front 5

Where does blood flow go in a PDA?

Back 5

1.Left to right shunt through the ductus.
2.Increased pulmonary blood flow (increased pulmonary pressure and pulmonary edema)
3.Decreased blood flow to the intestines (increase NEC), skin and kidney. (decreased uop, increased creatinine)
4.Increased fluctuation of blood flow to the heart and brain

Front 6

What does a PDA sound like?

Back 6

soft, short, systolic murmur heard best at the left upper sternal border

Front 7

What are other signs a/w PDA?

Back 7

1.Murmur
2.Increased peripheral pulses
3.Hyperactive precordium
4.Decreased diastolic and MAP and a wide pulse ressure
5.Pulmonary edema - worsening respiratory status (rales, increase oxygen need, enlarging liver,cardiomegaly)
6.Apnea and bradycardia (late)

Front 8

What's the treatment for PDA?

Back 8

1.Indomethacin (x 3 doses)
2.Surgical closure

Front 9

When should you treat a PDA?

Back 9

1. <1000 g : prophylactic indomethacin, and if reopens do surgical closure
2. >1000 g :
-murmur,
-increased pulse pressure/volume,
-active precordium,
-increased pulmonary markings on CXR

Front 10

What are contraindications to Indomethacin?

Back 10

1. Active bleeding
2. NEC
3. Creatinine > 1.6
4. Active IVH

Front 11

What should you monitor with Indomethacin?

Back 11

1.Plt count (>75, or transfuse)
2.Creatinine level before each dose
3.Uop (lasix if needed)
4.NPO until 24 hr after therapy b/c of decreased GI blood flow
5.Repeat echo 72 after treatment.