Patent Ductus Arteriosus Symptoms in Indian Infants

Introduction

Patent Ductus Arteriosus is a condition where the communication between the two main blood vessels leading from the heart does not close after birth. The ductus arteriosus, or the opening, is the normal part of a child’s circulatory system when the child is inside the womb, which closes right after birth. But if it remains open, the condition is termed Patent Ductus Arteriosus¹. 

On certain occasions, Patent Ductus Arteriosus does not require any treatment, but if left untreated, it will cause poorly oxygenated blood to flow in the wrong direction. Untreated, large patent ductus arteriosus can also cause heart failure, weaken the heart muscles and cause various other complications. A thorough understanding of the symptoms can facilitate an early diagnosis and more effective treatment. Several treatments for ductus arteriosus closure are available in India, and you must consult a doctor. 

Read on to learn more about Patent Ductus Arteriosus symptoms, causes, diagnosis and treatment options.

What Is Patent Ductus Arteriosus?

The fetus’s blood doesn’t need to reach the lungs to be oxygenated before birth. Instead, the placenta facilitates gas exchange between the mother and fetus. The ductus arteriosus is a communication between the aorta (the heart’s major blood vessel) and the pulmonary artery (a blood vessel that carries oxygen-deficient blood from the heart to the lungs) that enables the blood to skip the circulation to the lungs. But when the child is born, the blood needs oxygen from the lungs, and the ductus arteriosus has to be closed. But if it remains open even after a few days of birth, it is called Patent Ductus Arteriosus (PDA).

In most babies with a normal heart, there will be no signs or symptoms of Patent Ductus Arteriosus because the PDA will shrink and then close on its own, and no treatment will be needed. But if it stays open for a long time, it will allow the oxygen-deficient blood to flow in the wrong direction.

If the PDA is large enough, it will surely cause some problems, and you need proper treatment to get relief from it. A small PDA that doesn’t close may also seal itself when the child is a year old.

Statistics: How common/rare is it in India and the world?

PDA is a condition usually found in preterm infants, especially in 70% of the infants who are less than 28 weeks and 80% in 24 to 25 weeks of gestation². This particular condition occurs in 15% to 37% of infants weighing less than 1750 grams at birth. These figures are high when compared with the incidences of 2/1000 newborns. Apart from India, symptoms of PDA were also found in infants globally. In the United States, about 3000 babies are diagnosed with this condition every year.

When does it occur? How does it develop?

The natural closure of the ductus arteriosus takes place 2 or 3 days after birth. If it remains open even after that, it is referred to as patent ductus arteriosus. This condition occurs more in babies who are born way too early(premature) than in babies who are born at full term. Patent ductus arteriosus causes problems when the opening is large and is not treated correctly.

Small PDA vs Large PDA implications for the baby

There are two types of patent ductus arteriosus: small PDA and large PDA. When a child has a large PDA, the extra blood flow becomes too much for the child’s heart to handle. This makes it a lot harder for them to breathe. This is mainly because PDA can increase the heart’s work, and the baby might have heart failure. When it comes to small PDA, the risk of developing heart failure is not that high. But if enough blood causes abnormal noises or a Patent Ductus Arteriosus murmur, and the PDA should be closed³.

Doctors can easily hear the patent ductus arteriosus murmur with the help of a stethoscope on a baby who has PDA. These symptoms for patent ductus arteriosus can also occur later in life due to increased blood flow into the lungs during the later years. The patent ductus arteriosus symptoms include pulmonary hypertension [high blood pressure within the blood vessels of the lungs], heart failure and heart rhythm abnormalities. Pulmonary hypertension treatment involves taking medications, or, in some cases, undergoing surgeries like atrial septostomy or lung transplant.

To Summarize

• PDA occurs when the opening between two heart blood vessels doesn’t close right after birth.
• The condition occurs more in infants who are less than 28 weeks old.
• PDA rarely takes place in full-term babies.
• Small PDA will not cause such issues as it can close on its own but a large PDA can cause heart failure in babies if left untreated.

Patent Ductus Arteriosus Symptoms and Signs in Newborns

When it comes to the signs and symptoms of PDA, you will come across many of them. If you do encounter them in your child, you must immediately consult a doctor. Given below are a few of the patent ductus arteriosus symptoms:

• Blue discolouration of the skin: The patent ductus arteriosus in newborns can turn their skin colour blue as they do not get enough oxygen.
• Excessive sleepiness: PDA can cause excessive sleepiness in infants, which means they will feel sleepy the whole day.
• Palpitations: This condition can also trigger palpitations in newborns, where the heart starts beating faster.
• Poor growth: The patent ductus arteriosus in newborns also affects growth heavily due to inefficient suckling and poor eating.
• Rapid breathing: Rapid or heavy breathing is also one of the signs of PDA, which also occurs in infants.
• Excessive sweating with crying or eating: Sweating heavily when eating and crying occurs in babies.
• Getting tired easily: An older child with PDA will undoubtedly feel very tired even after engaging in a few activities.

When to see a doctor?

You should consult the doctor when your child gets tired after eating or playing, does not gain proper weight, or becomes breathless when crying or eating. The doctor will check the type of issue your child is experiencing. Whether it’s a patent ductus arteriosus surgery or PDA medication, the doctor will offer the best treatment plan to help reduce symptoms of Patent Ductus Arteriosus in your child. You need to follow all the doctor’s instructions without delay.

To Summarize

• There are several symptoms for Patent Ductus Arteriosus, like palpitations, excessive sweating while crying or eating, rapid breathing and poor growth.
• The condition can also make a child’s skin turn blue because of the lack of oxygen.
• You must immediately contact the doctor if your child becomes breathless while eating or crying, is not gaining enough weight and gets tired after eating and playing.

Causes of Patent Ductus Arteriosus

The causes of PDA are unknown; it usually occurs during heart development. However, genetic factors and premature birth are known to play a role.

Family history and other genetic conditions

Experts are currently not aware of what causes PDA, but congenital heart issues like hypoplastic left heart syndrome (a heart defect found at birth that affects normal blood flow through the heart) can cause this condition. Genetics play a massive role here because PDA in newborns can occur due to the genetic disorder, Down Syndrome. Apart from that, babies suffering from Neonatal Respiratory Distress Syndrome (a breathing disorder that occurs in infants whose lungs are not yet fully formed) can also develop PDA⁴.

Premature birth

Premature birth is one of the leading causes of PDA. If you are child was born prematurely, there is a high chance that he or she might have this particular condition. Gettingialist and prepare accordingly.

Risk factors

The PDA heart defect comes with numerous risk factors, which include:

• Rubella infection in the mother during pregnancy: If you have contracted Rubella (a viral infection) or German Measles during your pregnancy, the risk of PDA heart defect in your baby will increase. Rubella crosses the placenta and then invades the circulatory system of the baby, which damages the organs, blood vessels and also the heart.
• Gender: PDA is more common in girls. The symptoms of PDA are found a lot more in females than males.
• High altitude births: Babies born above 2800 feet or 2499 meters have a high chance of developing PDA compared to babies born in low altitudes⁵.

To Summarize

• Numerous reasons, such as family history, other genetic disorders and premature birth can cause PDA.  The condition is also found in infants suffering from Neonatal Respiratory Distress Syndrome.
• Some risk factors for this condition are high-altitude births and the rubella virus.
• PDA occurs more commonly in girls than in boys.

Diagnosis & Treatment of Patent Ductus Arteriosus

When it comes to patent ductus arteriosus diagnosis, there are several tests, which you can opt for. These tests will provide you with information about the type of PDA your baby is suffering from. Read on to learn more about diagnostic tests for patent ductus arteriosus.

List of diagnostic tests

• Chest X-ray: Chest X-ray is the test that allows doctors to see the condition of a baby’s lungs and heart. Premature babies might not have the same conditions as full-term babies and must undergo other tests to confirm the condition.
• Echocardiogram: Echocardiogram is the gold standard test, a useful Patent Ductus Arteriosus that utilizes sound waves to create an image of the baby’s heart. The painless procedure will enable the doctor to see the heart’s structure and assess the patent ductus arteriosus. The doctor will tell you whether to go for patent ductus arteriosus surgery or medication by looking at the images.
• Electrocardiogram: EKG or Electrocardiogram is another method that helps record electrical activity in the heart and detect irregular heart rhythms. EKG can also detect an enlarged heart in babies.
• Cardiac Catheterization: In this procedure, a catheter (thin tube) is inserted into an artery (blood vessel) in the arm or groin. Then, it is navigated through the blood vessel into the aorta (the largest artery) and the heart. Several tests can be carried out once the catheter is in the intended place. Cardiac catheterisation is not always necessary for diagnosing PDA. However, it is done to examine all the other congenital heart problems found in echocardiograms or when a catheter procedure is considered for treating this condition.

Preparing for diagnosis – what mothers need to be aware of, prepping for your baby

The first step for patent ductus arteriosus management is to prepare for the diagnosis. You need to be well aware of the pre-appointment restrictions. When making an appointment with the doctor, ask whether or not you have to do anything in advance like restrict your and your child’s diet.

Apart from that, write down all the symptoms you and your child are experiencing. You must also list symptoms unrelated to PDA or another heart problem. When making preparations for the diagnosis, you must jot down all the main information, which includes a family history of heart problems.

You must also carry all copies of the past medical records, including past reports of imaging tests or surgeries. Along with that, you must also list down all the medications, supplements and vitamins which your child takes. Providing all the documents and information to the doctor will not just help you with the patent ductus arteriosus management. Still, it will also allow the doctor to conduct the right test on your child.

Treatment Methods

There are various treatment options available for PDA that can help reduce the symptoms of Patent Ductus Arteriosus in your child. These treatments include:

• Close monitoring if it’s a premature baby: In a premature baby, the PDA sometimes closes by itself. The doctor will make sure to monitor your child’s heart to check whether or not the blood vessels are closing correctly. Monitoring will be required for all full-term babies, adults, and children who have small PDAs and are not causing any issues.
• Corrective surgery: You should only opt for PDA surgery when the medications are not working and your child’s condition can become severe or cause complications. In PDA surgery, the surgeon will make a small cut between the ribs to reach the heart. Afterwards, the surgeon will repair the open ductus with clips and stitches. After the surgery, your child should stay at the hospital for a few days for observation, and it will take several weeks for your child to recover entirely from the heart surgery. The patent ductus arteriosus in adults can also be treated through proper surgery without any issues.
• Catheter procedures: The doctor inserts a catheter into the blood vessel in the arm, groin or neck and guides it to the heart using X-ray or ultrasound imaging. The doctor inserts specialised devices to correct the defect. It is not advisable to carry out catheter procedures in premature babies. But if your child doesn’t have any PDA-related complications, your doctor might suggest you wait until your baby is a bit older for the catheter procedure to fix the PDA. Catheter procedures are ideal for treating patent ductus arteriosus in adults and full-term babies.
• Medication: Back in the past, adults, babies, and even children who had PDA were advised by doctors to take antibiotics right before specific surgical procedures or dental work, to help prevent endocarditis (inflammation of the heart’s inner lining). You can and your baby can take preventive antibiotics for the first 6 months after the catheter procedure when you had a heart infection previously or there are damages after the procedure. Some medicines also help in the closure of small PDAs. Be sure to consult your child’s doctor before giving any medicine to your child⁶.

Follow-up care and regular checkups

When you have PDA and have also had surgery as a child, you might be in danger of developing complications as an adult. For such reason, you must opt for life-long follow-up care, especially when you had corrective heart surgery. Follow-up care is just like periodic checkups. Otherwise, regular screening might also be required to detect any. You must discuss your care plan with the doctor and follow all their recommendations without fail.

To Summarize

• There are several ways through which PDA is diagnosed, such as chest x-ray, electrocardiogram, echocardiogram, and cardiac catheterisation.
• You must prepare yourself for the PDA diagnosis, and you must provide all the documents and reports of previous surgeries, medication and imaging tests.
• You must also provide a list of symptoms to the doctor, that you and your child experienced.
• A few of the treatment procedures for PDA include corrective surgery, preventive antibiotics and catheter procedures.

How to Prevent Patent Ductus Arteriosus in Infants?

Most of the PDA cases get diagnosed and treated right after the birth of the child. It’s pretty unusual for PDA to go unnoticed during adulthood, and if it does, this condition will cause many health issues.

If the openings are larger, it will cause many complications. Given below are a few of the complications that patent ductus arteriosus might lead to:

• High BP in the lungs’ blood vessels: When the large PDA is left untreated, it can damage your child’s lungs and heart and cause high blood pressure in the lungs. In other words, when too much blood is forced into the pulmonary artery, it will lead to high blood pressure, also known as pulmonary hypertension. You must opt for immediate treatment for the large PDA so that you can avoid the increase in the lungs’ blood pressure levels.
• Heart failure: A small PDA may not cause any major issues. On the other hand, a large PDA allows poorly oxygenated blood to flow in the wrong direction. This results in the weakening of the heart muscle, which can lead to heart failure. You must speak with your doctor to receive the correct treatment or medication for the large PDA so that heart failure can be prevented.
• Heart infections: The doctor will prescribe certain medications if you or your child has previously had heart infections. These medications are essential, especially if you or your child has undergone a catheter procedure.

Precautions PDA children need to take to prevent complications [maintain good personal and oral hygiene, restricting specific exercises and physical activity]

Children who have the patent ductus arteriosus have to take precautions so that they can prevent further complications from occurring. Here are some of the preventive measures:

• Maintaining good personal and oral hygiene: It’s essential to maintain oral and personal hygiene when it comes to preventing PDA complications. You should wipe off the baby’s gums with a soft, wet cloth after each feeding, and you can begin brushing when the first tooth erupts. This will help in preventing oral decay. Both older children and babies must bathe regularly to stay clean. Older children should brush their teeth in the morning and at night after dinner.
• Restricting specific exercises and physical activities: Children who undergo a PDA treatment or surgery must limit some of the physical activities or exercises, as they can lead to complications. You must speak to the doctor about which activities and exercises are safe for your child and which can cause problems.

Tips for expecting mothers to reduce the risk of developmental anomalies in their babies

No way can surely prevent PDA from occurring in some babies. But in general, expectant mothers can follow some tips for a healthy baby and a comfortable pregnancy. These tips are:

• Healthy diet: Maintaining a healthy diet while pregnant will keep your child safe and prevent PDA.
• Seeking early prenatal care, even before you are pregnant: Managing stress and quitting smoking are things that you must discuss with the doctor right before you think of getting pregnant.
• Exercise regularly: You should work with your doctor to create an exercise plan, which you should follow regularly.
• Avoid the use of alcohol, tobacco or drugs: When you are pregnant, don’t consume alcohol or drugs.
• Control diabetes and blood pressure: Keep your blood sugar in check and work with your doctor to create a proper plan. The most common causes of high blood pressure include smoking, stress, lack of physical activity and being obese. Avoiding these can help keep blood pressure levels under control.

Planning a pregnancy with a history of PDA

The majority of the women who have PDA can handle pregnancy without any issues. But having large complications or defects like pulmonary hypertension and heart failure can increase the risk of complications during pregnancy. If you have a history of PDA or any other heart-related problem, you must consult your gynaecologist before planning pregnancy.

To Summarize

• Complications of PDA that can occur are heart failure, cardiac infection and high blood pressure in the lungs.
• Children suffering from PDA should restrict themselves from engaging in specific exercises and maintain their oral and personal hygiene.
• Soon-to-be mothers can take care of their health by maintaining a healthy diet, exercising regularly, avoiding smoking and drinking alcohol and controlling their blood sugar levels.
• You must speak to a genetic counsellor if you have a history of PDA and other heart-related problems.

Support and Coping Mechanisms for Parents

• Seeking support from friends and family members: When your child is suffering from PDA, you will require the support of your family members and friends to help you through the situation. 
• Increasing awareness of the condition: what to do, what not to do, building a lifestyle/routine/diet, etc: You must increase the awareness of PDA by educating others about it. You should also maintain a good diet packed with heart-healthy foods for your child and make them follow the diet chart for heart patients and a proper routine to adequately manage symptoms for Patent Ductus Arteriosus. Make sure to seek help from the doctor when needed.
• Recording/journaling your baby’s health in every stage of life: When your child has PDA, you must keep a journal or record your baby’s health properly.
• Joining a parenting support group where you can talk about your concerns: Joining a community where you can speak about PDA and its concerns will allow you to learn more about the condition and seek comfort from parents facing similar situations.
• Preparing for your doctor visits: Some of the questions you can ask your doctor and answers you can be prepared for: When preparing for the doctor’s visit, you will have many questions in your mind. After learning about the symptoms and running some tests, the doctor can only provide you with a solid answer.

PDA or patent ductus arteriosus occurs mostly in premature babies. The condition can become worse if it’s left untreated. Excessive sweating, tiredness, bluish appearance of the skin, and palpitations are some of its symptoms. The outlook of the condition looks good when PDA is detected earlier and is treated with medications.

To Summarize

• When your child is suffering from PDA, you will require love and support from your family members and friends.
• Prepare a list of questions you want to ask your doctor when visiting them.
• Spread awareness of the condition and join a community for PDA to discuss the concerns.
• Keep a journal or a recording of your baby’s health.

Frequently Asked Questions (FAQs)

References

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5. Hasan A. Relationship of high altitude and congenital heart disease. Indian Heart J. 2016 Jan-Feb;68(1):9–12. doi:10.1016/j.ihj.2015.12.015. PMID: 26896259; PMCID: PMC4759507. Available from: https://pubmed.ncbi.nlm.nih.gov/26896259/
6. Herrera C, Holberton J, Davis P. Prolonged versus short course of indomethacin for the treatment of patent ductus arteriosus in preterm infants. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD003480. doi:10.1002/14651858.CD003480.pub3. PMID: 17443527; PMCID: PMC8715534. Available from: https://pubmed.ncbi.nlm.nih.gov/17443527/

Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof.

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