What are the conservative management options for patent ductus arteriosus (PDA)?

Updated: Nov 20, 2018
  • Author: Luke K Kim, MD; Chief Editor: Stuart Berger, MD  more...
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Answer

Because patients presenting with a patent ductus arteriosus (PDA) are usually asymptomatic, no acute management is needed. However, until the patency of the ductus is corrected, administer antibiotics in patients during instances of high exposure to bacteremia (eg, instrumentation, dental procedures), as recommended by the American Heart Association for the prevention of bacterial endocarditis. [4]

Conservative standards include adaptation of ventilation by lowering inspiratory time and giving more positive end expiratory pressure (PEEP). [5] Furthermore, fluid restriction that does not exceed 130 mL/kg/d beyond day 3 is also used. This has been found to have a high closure rate of patent ductus arteriosus (PDA).

In infants who present with congestive heart failure (CHF), the standard treatment of digoxin and diuretic therapy usually palliates the condition. These children can be treated until they are several years old and are good candidates for ductal closure. When medical treatment of congestive heart failure fails in infants, the patients are referred early for surgical closure of the structure.

Closure of the patent ductus arteriosus (PDA) is stimulated by administration of prostaglandin synthesis inhibitors, such as indomethacin or aspirin, which is effective in premature infants (see Pharmacologic Management and Medication). Indomethacin (0.1 mg/kg body weight) is administered orally at 8-hour intervals. This treatment is particularly valuable in premature infants presenting with respiratory distress syndrome complicated by left-to-right shunting through the ductus.

One study concluded that B-type natriuretic peptide can be used to guide treatment, reducing the number of primary indomethacin doses. [6]

Additionally, a study of 50 preterm infants born at less than 33 weeks’ gestation found that obtaining N-terminal-pro-brain natriuretic peptide (NT-proBNP) levels on day 2 of life may be an effective guide for early targeted indomethacin therapy for PDA in preterm infants. This method may reduce later onset of hemodynamic significant PDA and unnecessary exposures to indomethacin. [7]


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