A mother or father with a newborn baby can feel very scared even if they notice a small change in their baby. So how worried would you be if the doctor examined the baby and said, "There is a small heart murmur"? But don't be afraid. Today we are talking about a heart condition that is often seen in newborn babies and is easily treatable. This is called Patent Ductus Arteriosus, or PDA as it is called among doctors for short.
Simply put, what is this PDA?
To understand this, let's go back to when the baby is in the mother's womb. Imagine, the baby does not breathe while in the womb. The baby gets the oxygen it needs through the mother's umbilical cord. Therefore, the baby's lungs do not work at that time. So, there is a small path, like a 'bypass' connection, between the main artery that carries blood from the heart to the body (aorta) and the artery that carries blood to the lungs (pulmonary artery). This is what we call in medicine `(ductus arteriosus)`. Its function is to bypass the lungs, which are not working, and send blood to the rest of the body.
After the baby is born and takes its first breath, the lungs start working. Then there is no need for that 'bypass' route. So usually within the first few days after the baby is born, this blood vessel will shrink and close on its own.
But in some babies, this blood vessel called ``ductus arteriosus'' doesn't close properly. It leaves a small hole. That's why we call it Patent Ductus Arteriosus (PDA) .
How does this PDA condition affect the baby?
Now, what happens when that bypass is not closed? The blood pressure in the main artery that carries blood to the body, the aorta, is high. The pressure in the artery that carries blood to the lungs, the pulmonary artery, is low. So through this hole, an unnecessary amount of blood flows from a place of high pressure to a place of low pressure, that is, to the lungs.
This causes two main problems:
1. More work for the heart and lungs: The baby's heart and lungs have to work harder to pump all this extra blood.
2. Lung damage: If this condition continues without treatment, the blood pressure in the lungs can increase, leading to a condition called pulmonary hypertension. This can also damage the blood vessels in the lungs.
The important thing is that all of these complications can be prevented if this condition is diagnosed early and treated properly.
Who is at higher risk of developing this PDA?
Although this condition can occur in any baby, some babies are at a higher risk.
- Premature babies: This is the main risk group. The fewer weeks a baby is born, the more likely it is to have a PDA. About 80% of babies born before 28 weeks can have this condition.
- Female babies: This condition is more common among female babies than male babies.
- Genetic causes: PDA can occur with certain genetic syndromes.
- Rubella infection in the mother during pregnancy: If the mother contracts German measles during pregnancy, the baby is at increased risk of developing PDA.
What are the symptoms of PDA?
Symptoms vary depending on the size of the PDA. A very small PDA may not show any symptoms . There may only be a heart murmur that the doctor can hear with a stethoscope. However, if you have a moderate to large PDA, you may notice these symptoms.
| Symptom | A simple explanation |
|---|---|
| Rapid breathing | Because more blood is flowing to the lungs, the baby breathes faster than normal. Sometimes shortness of breath may occur. |
| Sweating while drinking milk | Because the heart has to work harder, even the simple act of drinking milk feels like a big workout to the baby. That's why his forehead and head sweat while drinking milk. |
| Getting tired easily and drinking less milk | The baby gets tired quickly, so he stops drinking a little milk. It's hard to keep drinking milk continuously. |
| Poor weight gain | Because the baby is not drinking enough milk and the body is spending too much energy, the baby's weight does not increase in a way that is appropriate for his age. |
| Rapid heartbeat | The heart beats faster to pump more blood. |
How do you find this, Doctor?
If you notice any of these symptoms in your baby, tell your doctor right away. Usually, when examining your baby, the doctor can hear a ``machinery murmur`` in the heart. This is when a PDA is suspected.
Then, to confirm this, you will be referred to a Pediatric Cardiologist . He may perform the following tests:
- Echocardiogram (Echo): This is the most important and accurate test . It is like a scan of the heart. It can clearly see everything like whether the PDA is present, how big it is, and how much blood is flowing through it. This is not a painful test.
- Chest X-ray: A chest X-ray can check whether the heart is enlarged or if there is too much blood flowing into the lungs.
- Electrocardiogram (ECG): By looking at the electrical activity of the heart, it can be determined whether the heart is under too much strain.
What are the treatments for PDA?
Treatment is determined by the baby's age, weight, health status, and the size of the PDA. Not all PDAs are treated at the same time.
1. Watchful Waiting
If it's a very small PDA, and it's not causing any harm to the baby, the doctor may decide to wait a while. Because some of them close on their own. But it's essential to continue to visit the doctor's clinic for checkups during this time.
2. Treatment with medication
Especially for premature babies , some medications (e.g., Ibuprofen, Indomethacin) are given through injections to try to close this PDA. These medications help the blood vessel contract and close. This is only successful in the first few weeks after the baby is born.
3. Cardiac Catheterization
This is not surgery. The baby is fully anesthetized, and a very thin tube (catheter) is inserted through a blood vessel in the groin and guided to the heart. Then, a small device (or coil) is passed through the tube and the PDA hole is closed. This is often done for slightly overweight babies who are a few months old. The advantage of this method is that the baby does not need to be bandaged, so the baby can recover quickly and go home.
4. Surgery
In some cases, especially for babies who are not suitable for catheterization or if the PDA is very large, surgery may be necessary. In this case, the surgeon makes a small incision on the side of the chest, under the armpit, and closes the PDA with stitches or a small metal clip.
What happens after treatment?
After treatment and closure of the PDA, the baby's blood flow returns to normal. The symptoms gradually disappear completely.
After treatment, the doctor will tell you to take antibiotics for about 6 months to prevent heart infection (endocarditis). It is also very important to go to the clinic on time and show the baby.
After receiving proper treatment, all babies with PDA go on to live healthy, active lives without any problems. So don't worry unnecessarily about this.
When to seek immediate medical advice
If you know your baby has PDA, call your doctor immediately if any new symptoms develop (e.g., decreased milk intake, difficulty breathing).
If your baby suddenly has difficulty breathing or his lips turn blue, take him to the nearest hospital's Emergency Department (ETU) without delay.
Take-Home Message
- PDA is a treatable heart condition seen in newborn babies.
- This risk is higher for premature babies.
- If your baby is breathing rapidly, sweating while breastfeeding, or not gaining weight, see a doctor immediately.
- This can be accurately diagnosed with a scan called an echocardiogram (Echo).
- There are treatment options (medication, catheterization, surgery). After proper treatment, the baby can live a completely healthy life.
- Don't be unnecessarily afraid of this. Talk to your doctor to get the most accurate information.
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