Thursday, February 19, 2009

PDA baby

I've had a few parents come into my clinic and just casually mention their child has/had a PDA.

So what on earth are they meaning? They were born with an inherant ability to tell you the time, calculate your diary, remind you of your impending appointments and meetings!?!

PDA means Patent Ductus Arteriosus. Ever heard of 'hole in the heart'? Basically its that.

"All babies are born with this connection between the aorta and the pulmonary artery. While your baby was developing in the uterus, it was not necessary for blood to circulate through the lungs because oxygen was provided through the placenta. During pregnancy, a connection was necessary to allow oxygen-rich (red) blood to bypass your baby's lungs and proceed into the body. This normal connection that all babies have is called a ductus arteriosus.

At birth, the placenta is removed when the umbilical cord is cut. Your baby's lungs must now provide oxygen to his/her body. As your baby takes the first breath, the blood vessels in the lungs open up, and blood begins to flow through to pick up oxygen. At this point, the ductus arteriosus is not needed to bypass the lungs. Under normal circumstances, within the first few days or weeks after birth, the ductus arteriosus closes and blood no longer passes through it. Most babies have a closed ductus arteriosus by 72 hours after birth".

In some babies, however, the ductus arteriosus remains open (patent) and becomes a problem, PDA. The opening between the aorta and the pulmonary artery allows oxygen-rich (red) blood to pass back through the blood vessels in the lungs, which should solely be carrying only oxygen-less (blue) blood.

PDA is common in the preterm infant and especially when respiratory distress syndrome (RDS) is present. Also genetic kiddlies like downs syndrome and kids are more at risk if mother had german measles (rubella) during the pregnancy. PDA is the sixth most common congenital heart defect, occurring in 6 to 11 percent of all children with congenital heart disease. Patent ductus arteriosus occurs twice as often in girls as in boys.

In pre-term infants the PDA normally closes on its own within the first few weeks of life. If the PDA is in a full-term infant, it is unlikely to close on its own. The PDA can be closed by giving a prostaglandin synthetase inhibitor (e.g. indomethacin), but sometimes surgical closure is required.

So when do the doctors check for this PDA? Usually they will hear it on the initial examination once your child is born. They listen for a murmur. Sometimes you won't hear it, then they go on the signs and symptoms later on.
Symptoms of a fairly larger PDA are:
  • Bounding pulse
  • Fast breathing
  • Poor feeding habits
  • Shortness of breath
  • Sweating while feeding
  • Tiring very easily
  • Poor growth
Then its on to the tests of an echocardiogram, chest x-ray, ECG, or cardiac catheterization.

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