All about PDAs

The first couple of weeks after X's birth were full of monitoring him very closely. He was stable finally and had been gaining weight. By the time he was 3 weeks old, he had gained half a pound and grown an inch longer. The bruising he'd had earlier had completely disappeared. He was making slow, steady progress. He'd been sick with a cold which was very scary. At that point, he still had no immune system and a cold could have easily been too much for his body to handle and he could have died. But, he made it through. He's a fighter!

X's first diaper compared to a $10 bill

Even though he was almost a month old, he was still fragile and unstable enough that we still hadn't been able to hold him. The most interaction we got with him was during his cares. Cares mean that we took his temperature, changed his diaper, his nurses would feed him through his ng tube (a tube that went through his nose down into his stomach), and he'd be re-positioned until his next cares.

Although he'd already been through quite a lot, the scariest part of his first three weeks for us were waiting for test results on his heart and his brain. You see, preemies are at risk for a number of complications. Their tiny bodies are just so fragile and they have to continue their development in a plastic box rather than in the womb.  The outcome of these tests were an indicator of his overall health and a glimpse at what his future might hold.

Today I'm going to talk about the tests for his heart and the condition that was being monitored: a condition called PDA (patent ductus arteriosus). Before a baby is born, their aorta and pulmonary arteries are connected by a little vessel called the ductus arteriosus. That little vessel is important in a baby that's still in the womb. It helps keep them properly oxygenated. Once a baby is born and takes their first breath, it triggers a response in their body that's supposed to close off that little vessel. It's no longer needed once a baby is breathing oxygen.

That closing happens anywhere from a few minutes to as long as a few days after baby's first breath. In some babies, like X, the ductus arteriosus doesn't close. That's what a PDA (patent ductus arteriosus) is. The word "Patent" just means open. So, PDA means the vessel that connected the arteries was still wide open when it should have closed.

The problem with it remaining open is that the blood from the aorta and the pulmonary arteries mixes. That mixing can put extra strain on the heart and cause increased blood pressure in the arteries leading to the lungs.

A PDA is actually a pretty common heart defect. It happens with full term babies as well, but it's 4 times more likely to happen in preemies. It's just one of MANY complications they can have. Sometimes the PDA will close on its own. Sometimes medication is needed. Sometimes surgery is needed. In X's case, his PDA was HUGE. But, he was handling it great and it wasn't causing any complications for him. So, his doctors decided to try a medication called Indocin in hopes that the PDA would improve.

Indocin is basically in the same family of drugs as ibuprofen (Advil, Motrin, etc). The idea is that it helps the PDA to shrink and hopefully close. In X's case, it caused the PDA to get a little smaller, but it didn't close. However, since he wasn't having complications, the doctors left it alone after a round of Indocin.

Picture A is a normal heart, Picture B is a heart with a PDA

Actually, X still has the PDA. His just never closed all the way. It's quite small now, and no longer causes him to have a heart murmur. He doesn't have any complications from it. He was seen by a cardiologist a few times during the past year to keep an eye on it. At the last visit we had, his cardiologist told us he feels that X can lead a perfectly normal life where his heart is concerned without surgery or any further intervention. We just have to be careful not to give him any ibuprofen for another year or so to make sure it stays closed up as much as possible. It's safe to say that the PDA is no longer really an issue. We don't even have to go back to the cardiologist anymore!