The document discusses treatment options for patent ductus arteriosus (PDA) in infants. There are three main options: medical management using drugs like indomethacin or ibuprofen, catheter-based procedures to close the PDA, or surgical intervention. Medical management is usually the first approach using anti-inflammatory drugs and involves balancing treatment against potential renal or gastrointestinal side effects. If medical management fails, catheter or surgical closure may be considered, with catheter procedures preferred if the PDA is suitable due to lower risks. Surgical ligation is an option when other approaches are not viable or have failed.

1. Dr. Abu Sayed Munsi Management of Patent Ductus Arteriosus Presented by

2. To treat or prevent Heart failure. To prevent infective endocarditis. To prevent development of pulmonary vascular disease. Aims of treatment:

3. There are 3 options for the treatment of PDA: Medical management Catheter based procedure Surgical intervention

4. Conservative management: a. Fluid restriction b. Diuretic theraphy c. Adequate calorie d. Ventilator support Drugs: Indomethacin Ibuprofen Medical management:

5. Indications of drug : Prophylactic: Indication: All infant <1250gm birth weight who have respiratory distress. Timing: Usually within 1 st 24 hours of life. Dose: 0.1 mg/kg/dose 24 hourly for 6 days.

6. Therapeutic: Timing : Usually within 1 st 14 days of life. Indications: 1. If there is any clinical sign of PDA in preterm baby. 2. There are signs of overt failure or congestive cardiac failure. 3. Re-treatment after failure of the first course indomethacin. 4. Recurrence of PDA after first course of indomethacin.

7. Indomethacin: Dose: O.2 mg/kg stat followed by <7days and birth weight <1250gm 0.1 mg/kg/dose 12 hourly for 2 doses >7days and birth weight >1250gm 0.2 mg/kg/dose 12 hourly for 2 doses

8. Adverse effects: Renal dysfunction Gastro-Intestinal bleeding Thrombocytopenia Periventricular Leucomalasia Contra-indication: Serum Creatinine >1.8 mg/dl Renal or gastro-intestinal bleeding NEC Sepsis

9. Ibuprofen: Dose: Initial dose of 10mg/kg followed at 24 hour intervals by two doses of 5mg/kg. As Ibuprofen has less adverse effect than Indomethacin, So Ibuprofen is superior than Indomethacin.

10. Catheter-based Procedures:

11. Timing: Usually done after neonatal period Catheter procedures available Small PDA with intra vascular coils. Moderate to Large PDA with a catheter introduced sac into which several coils are released or with an umbrella-like device.

12. Device used in Catheter-Based Procedures:

13. Trans Catheter procedure: Sedation A small incision is given in the inner thigh A long, thin, flexible, hollow tube is inserted through the femoral vein Implantation of device to PDA through tube.

14. Surgical Intervention: Indications: A Premature or Full-term infant with symptomatic heart failure from the PDA in whom medical treatment has failed or in whom there is a contraindication to the use of drugs. A PDA isn’t successfully closed by a Catheter-based Procedure. Large PDA which is unsuitable for Trans catheter closure.

15. Timing: Usually after 6 months of age. Procedure: Ligation and division of ductus via Thoracotomy.

16. Complications: Bleeding Pneumothorax Chylothorax Infection Thoracic scoliosis

17. Surgical repair of PDA

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