PDA Management in the First Month in High-Risk Preterm Neonate, N/IICU and Inpatient – PDA Surgical Closure and Percutaneous Intervention Recommendations

PDA Management in the First Month in High-Risk Preterm Neonate, N/IICU and Inpatient – PDA Surgical Closure and Percutaneous Intervention Recommendations

PDA Surgical Closure and Percutaneous Intervention Recommendations

Requests for PDA closure should begin with the appropriate consulting cardiologist.

Recommendations

PDA Surgical Closure
  • The decision to close a PDA should be based primarily on clinical assessment.
  • Infants in Moderate to Severe Clinical Stage should be considered for closure if 2 courses of pharmacotherapy with no improvement or worsening in status, or if there is a contraindication to use of these medications.
  • Significant compromise: clinical and echocardiographic evidence of left sided volume overload as evidenced by 1 or more findings of the clinical assessment in the “severe” category or 2 or more findings in “moderate” category.
  • Before closure is decided upon, the infant should be carefully evaluated to ascertain that the symptoms are attributable to a PDA and not clearly attributable to other causes. Infants with a symptomatic PDA will generally have findings of a moderate to large PDA on echocardiogram (1 or more).
PDA Percutaneous Intervention
  • Consider percutaneous ductal closure if neonate has large PDA with clinical evidence of left sided volume overload as evidenced by 1 or more findings of the clinical assessment in the “severe” category or 2 or more findings in “moderate” category.
  • Can be considered in:
    • All neonates > 1000 g
    • High risk neonates > 700 g