Managing Patent Ductus Arteriosus in Premature Infants

One of the key characteristics of fetal circulation is the presence of an open ductus arteriosus along with a patent foramen ovale. In full-term infants born between 38 to 40 weeks, the lungs expand fully after birth, filling with air and triggering the closure of both the ductus arteriosus and the foramen ovale. This marks a normal physiological transition. Typically, these structures close completely within one to two weeks after birth. However, preterm infants often remain in the fetal circulation phase, where an open foramen ovale and patent ductus arteriosus are quite common.

Medical Treatment for Patent Ductus Arteriosus

In cases where a premature baby's ductus arteriosus remains open, the first-line treatment is usually pharmacological intervention. The ductus arteriosus contains a specific group of epithelial cells that respond uniquely to certain medications. These drugs can effectively stimulate the closure of the ductus arteriosus. Medication is often the preferred initial approach due to its non-invasive nature and relatively low risk profile.

When Surgery Becomes Necessary

Indications for Surgical Intervention

If the diameter of the ductus arteriosus is particularly large or if medical therapy proves ineffective, surgical intervention may be required. Surgery can be performed either at the bedside or in an operating room, depending on the infant's stability and overall condition. The procedure is relatively straightforward and does not require the use of cardiopulmonary bypass.

The Surgical Procedure

The operation involves making a small incision under the left armpit of the newborn. Due to the close proximity of the aorta to the chest wall in infants, the surgeon can access and ligate the ductus arteriosus efficiently. This procedure, known as ductal ligation, effectively stops the left-to-right shunting of blood caused by the persistent opening. It provides a reliable solution for managing complications associated with a patent ductus arteriosus and supports the infant's cardiovascular development.