Patent Ductus Arteriosus is the complete reference for faculty, practitioners, trainees and students for one of the most controversial topics in neonatology. Concise, easy to use, and authoritative, this text is designed to help you learn and understand how to diagnose and manage patent ductus arteriosus (PDA) in preterm infants. Each chapter is organized in a practical and logical way that reflects the clinical approach to patients. Features include: Emphasizes a pathophysiological approach to the diagnosis and management of PDA, integrated within neonatal intensive care Comprehensively reviews the echocardiography approach to PDA diagnosis and staging,complete with high quality illustrations Detailed framework for the enhanced care of the preterm infant undergoing surgical ligation of the patent ductus arteriosus
- Patent Ductus Arteriosus
- INTRODUCTION
- SECTION 1 • DUCTUS ARTERIOSUS: EMBRYOLOGY AND FETAL PHYSIOLOGY
- SECTION 2 • DUCTUS ARTERIOSUS CLOSURE
- Determinants of ductus arterious closure
- Persistent Patency of the Ductus Arteriosus in Preterm Infants
- Physiological Immaturity
- Pharmacological agents
- Prostaglandin and phosphodiesterase inhibitors
- Drugs used in pregnancy
- Furosemide
- Aminoglycosides
- H2 Receptor Antagonists and Cytochrome P450 Inhibitors
- Genetics and persistent PDA in preterm infants
- SECTION 3 • PHYSIOLOGICAL PRINCIPLES AND CONTINUUM OF THE DUCTAL SHUNT IN NEONATES
- Critical congenital heart disease
- Persistent pulmonary hypertension of the newborn
- Congestive heart failure
- SECTION 4 • THE CLINICAL IMPORTANCE OF PATENT DUCTUS ARTERIOSUS IN PRETERM INFANTS
- PDA and Severe Morbidities of Prematurity
- Intraventricular hemorrhage
- Bronchopulmonary dysplasia
- Necrotizing enterocolitis
- SECTION 5 • DIAGNOSIS OF PATENT DUCTUS ARTERIOSUS
- Clinical Examination
- Electrocardiogram
- Chest radiograph
- Echocardiography
- Comprehensive echocardiographic assessment of the PDA
- Assessment of the ductus arteriosus
- Ductal diameter
- Transductal Doppler flow pattern
- Pulmonary artery diastolic flow
- Assessment of pulmonary overcirculation and left heart volume loading
- Left ventricular chamber size and output
- Left atrial pressure and volume loading
- Systemic Steal
- Cardiac biomarkers: BNP and NT-pro BNP
- BNP/NTpBNP and asymptomatic ductal shunting
- BNP/NTpBNP and the diagnosis of hemodynamically significant PDA
- BNP / NTpBNP and determining response to medical PDA treatment
- Magnetic resonance imaging
- SECTION 6 • THERAPIES TO MANAGE PATENT DUCTUS ARTERIOSUS
- Ductal closure strategies
- Cyclooxygenase inhibitors
- Acetaminophen
- Surgical ligation
- Conservative measures: Strategies to limit shunt volume or improve physiological tolerance of the ductal shunt
- Oxygen saturation
- Positive end-expiratory pressure and pulmonary vascular resistance
- Hematocrit
- Diuretics
- Fluid restriction
- SECTION 7 • CURRENT EVIDENCE REGARDING THERAPIES USED TO TREAT THE PDA
- Prophylaxis
- Early vs. Late symptomatic treatment
- Indomethacin and ibuprofen
- Acetaminophen
- Surgical ligation
- Permissive approach to the patent ductus arteriosus
- SECTION 8 • PDA, NEONATAL MORBIDITIES AND CASUALITY: LACK OF A STANDARIZED ASSESSMENT OF A HEMODYNAMICALLY SIGNIFICANT PDA
- SECTION 9 • FRAMEWORK FOR ENHANCED CARE OF THE PRETERM INFANT WITH PDA
- Early targeted PDA treatment
- Comprehensive evaluation and diagnosis of a hemodynamically significant PDA: clinical examination, echocardiography and biomarkers
- The echocardiography PDA score
- Role of biomarkers
- PDA ligation
- The PDA ligation decision: Timing, patient selection and staging
- Pre-operative management
- Intra-operative management
- Post-operative physiology and post ligation cardiac syndrome
- Post-operative management
- SECTION 10 • EXECUTIVE SUMMARY
- References
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