Sep 2026· Journal of Clinical and Diagnostic Research· 0 citations
TL;DR
Lower gestational age and lower birth weight were significantly associated with persistence of PDA, indicating prematurity as a major determinant, highlighting PDA as a prevalent condition contributing significantly to early complications and death.
Abstract
Introduction: Patent Ductus Arteriosus (PDA) refers to a persistent vascular connection between the pulmonary artery and the aorta. In a healthy newborn, this foetal vessel typically undergoes functional closure shortly after birth, followed by anatomical sealing. If the shunting is substantial, it can lead to significant haemodynamic instability. PDA is a common cardiovascular condition seen in neonates, particularly in preterm infants. As preterm birth is a significant contributor to neonatal mortality in India and other low-middle-income countries, understanding how PDA contributes to this burden is essential. By limiting the study to one specific rural hospital, the findings are highly relevant for similar settings and may serve as a baseline for future larger-scale or multicentric studies.
Aim: To determine the prevalence of PDA on day 3 and day 7 of life in preterm neonates admitted to a rural neonatal intensive care unit and to assess its determinants, particularly gestational age and birth weight.
Materials and Methods: The present prospective observational study was conducted in a rural tertiary care hospital, Neonatal Intensive Care Unit (NICU), Department of Paediatrics, at JNMC and AVBRH, Sawangi (Meghe), Wardha, Maharashtra, India from January 2023 to September 2024. A total of 100 preterm neonates with gestational age up to 34 weeks admitted to the neonatal intensive care unit were included. Echocardiographic assessment was performed on day 3 of life and repeated on day 7 in neonates with PDA. Determinants such as gestational age and birth weight were analysed. Data were analysed using statistical software, and Chi-square test was used to find association of gestational age and birth weight with PDA. A p-value less than 0.05 was considered statistically significant.
Results: On day 3 of life, PDA was detected in 76% of preterm neonates. On repeat echocardiography on day 7, persistence of PDA was observed in 27% of neonates. Lower gestational age and lower birth weight were significantly associated with persistence of PDA, indicating prematurity as a major determinant.
Conclusion: The present study highlights PDA as a prevalent condition contributing significantly to early complications and death. The most affected infants were those born before 30 weeks of gestation and those with extremely low birth weights.
Patent ductus arteriosus (PDA) is a common congenital heart defect. PDA disproportionately affects low-birth-weight infants, resulting in an incidence of 21% among preterm births as compared to 0.05% in the general population. The ductus arteriosus remains patent in the fetus, allowing maternal blood to directly enter fetal systemic circulation, bypassing the fetal lungs. This is mediated through the mechanisms of nitric oxide and prostaglandins. At birth, increased partial pressure and decreased prostaglandin levels facilitate functional closure of the ductus arteriosus. Further migration of contractile smooth muscle cells and tissue remodeling results in fibrosis and anatomical closure of the ductus. Underdevelopment of contractile smooth muscle cells, the intimal layer in blood vessels, and vasa vasorum have been theorized as the mechanisms behind PDA in preterm-birth neonates. PDA creates a left-to-right shunt, sending oxygenated blood from the aorta to the lungs via the pulmonary artery, often manifesting with symptoms of pulmonary hypertension and edema. As the symptoms progress, the shunt is often reversed, resulting in cyanosis in a condition known as Eisenmenger syndrome. While most affected patients present with distinguishing clinical findings, many also remain asymptomatic, and the defect goes undetected for years.
Rithvik Swamynathan, L. Dolan, William H. Frishman et al.· Cardiology in Review· 0 citations
Background Patent ductus arteriosus (PDA) is common in preterm infants. Although pharmacologic treatment promotes ductal closure, its impact on clinically meaningful outcomes remains uncertain. This study aimed to evaluate the association between different pharmacologic PDA treatment strategies and major neonatal outcomes. Methods This retrospective cohort study included preterm infants born at <32 weeks’ gestation who received pharmacologic treatment for clinically significant PDA following an integrated echocardiographic and clinical assessment in a tertiary-level neonatal intensive care unit between 2018 and 2024. Infants were categorized by treatment strategy (ibuprofen only, paracetamol only, or sequential therapy), treatment timing, and number of treatment courses. The primary outcome was a composite of bronchopulmonary dysplasia (BPD) and/or mortality. Secondary outcomes included intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity, and sepsis. Results A total of 76 preterm infants were included, with a median gestational age of 28 weeks (IQR 26–30) and mean birth weight of 1,076 ± 343 g. Infants were treated with ibuprofen only (n = 31, 40.8%), paracetamol only (n = 27, 35.5%), or sequential therapy (n = 18, 23.7%). The composite outcome occurred in 39 infants (51.3%) and did not differ significantly across treatment groups. In multivariate analysis, gestational age emerged as the strongest independent predictor of BPD and/or mortality (adjusted OR 0.54, 95% CI 0.38–0.77; p = 0.001), while treatment category was not independently associated with outcomes. Conclusion Pharmacologic PDA treatment strategies were not independently associated with BPD and/or mortality in this retrospective cohort. Gestational age showed the strongest association with the primary outcome; however, residual confounding and limited statistical power preclude causal or equivalence conclusions.
Ercan Tutak, Nimet Cındık, Eser Doğan et al.· Frontiers in Pediatrics· 0 citations
BACKGROUND Hemodynamically significant PDA during pregnancy requires closure to reduce risk of maternal and fetal mortality and morbidity. But PDA device closure during pregnancy is complex in light of elevated maternal and fetal risk as well as radiation exposure to the fetus.
CASE PRESENTATIONCase 1: A 22-year-old female referred for PDA device closure. She was 26 weeks pregnant. She presented with the complaint of shortness of breath and palpitation before pregnancy, and an increase in the above symptoms for a month. A 14x16 ADO device was used to close the PDA. An echocardiogram was used to confirm closure of the duct. The total fluoroscopy time for this procedure was 0.7 min with radiation exposure of 9.5 mGy.Case 2: A 28-year-old female referred for PDA device closure by the cardiac surgeon. She was 28 weeks pregnant. She presented with the complaint of shortness of breath for 3 weeks. A 16x18life tech PDA device ADO device, was used to close the PDA. An echocardiogram was used to confirm closure of the duct. The total fluoroscopy time for this procedure was 1.3 min with radiation exposure of 28 mGy. An echocardiogram performed the next day following device implantation demonstrated no evidence of obstruction to either branch pulmonary artery or across the aorta, and no residual shunting across the duct. Case 3: A 31 years old female referred for PDA device closure. She was G2P1 with 26 weeks pregnant. She presented with the complain of shortness of breath of 4 weeks. A 16x18life tech PDA device was used to close the PDA. Echocardiogram was used to confirmed closure of the duct. The total fluoroscopy time for this procedure was 1.5 min with radiation exposure of 28mGy. An echocardiogram performed next day following device implantation, demonstrated no evidence of obstruction to either branch pulmonary artery or across the aorta and, no residual shunting across the duct.
CONCLUSIONS Unrepaired PDA discovered late in pregnancy poses management challenges. With our experience of doing adult PDA, we could do the procedure with very short exposure to radiation of the fetus.
C. Adhikari, B. Timalsena, A. Bogati et al.· Journal of Advances in Inter...· 0 citations
Introduction Transposition of the great arteries (TGA) is one of the critical congenital heart diseases of the newborn. The transition from fetal to postnatal circulation in these infants is complex, and the presence of persistent pulmonary hypertension of the newborn (PPHN) during this period may affect surgical outcomes. This study aims to evaluate the impact of PPHN on perioperative morbidity and mortality in infants with TGA. Materials and methods The study was conducted between December 1, 2024, and December 1, 2025, in two high-volume cardiac centers, involving newborns diagnosed with TGA. Patients were divided into two groups—PPHN and non-PPHN—based on clinical and echocardiographic findings. The groups were evaluated for early-term (first 30 days) mortality and morbidity. Findings were analyzed statistically. Results A total of 48 newborns with TGA (60% male) were included. The median age at operation was 5 days (IQR 3–7), median weight was 3,100 g (IQR 2,900–3,400), and the median preoperative oxygen saturation was 76% (IQR 70–82). Balloon atrial septostomy was performed in eight infants prior to ASO. PPHN was identified in thirteen infants (27%). Postoperative complication rates—including duration of vasopressor use, duration of sedative medication, length of hospital stay, and duration of mechanical ventilation—were higher in the PPHN group (p < 0.05). Overall mortality was 10.4%, with no significant difference between the PPHN and non-PPHN groups (15.3% vs. 8.5%; p = 0.60). Conclusion In newborns with TGA, PPHN was associated with increased postoperative morbidity. While no statistically significant difference in early mortality was observed, larger multicenter studies are needed to better define the impact of PPHN on mortality risk.
Halise Zeynep Genç, H. Ceylan, Hacer Kamalı et al.· Frontiers in Cardiovascular...· 0 citations
ABSTRACT Background Patent ductus arteriosus (PDA) and patent foramen ovale (PFO) are two fetal cardiovascular shunts that normally undergo functional and anatomical closure shortly after birth. While PDA is a well‐recognized congenital defect in veterinary cardiology, the haemodynamic interaction between PDA and PFO has received little attention, particularly in neonates. Objectives To review the physiological and pathophysiological relationship between PDA and PFO and evaluate available evidence from veterinary and comparative human literature. Review Content Increased pulmonary blood flow and secondary pulmonary hypertension associated with PDA may alter right‐sided cardiac pressures and predispose affected neonates to persistent or reopened PFO, potentially resulting in interatrial shunting and cyanosis. PDA represents one of the most prevalent congenital cardiac defects encountered in canine medicine and constitutes a substantial proportion of congenital heart diseases in dogs. Conversely, PFO appears to be less frequently recognized in veterinary patients, likely because many affected animals remain clinically asymptomatic. In human medicine, persistence of the foramen ovale has been identified in approximately one‐quarter of the adult population. This narrative review summarizes the physiology and pathophysiology of ductus arteriosus and foramen ovale closure, analyses the mechanisms by which PDA can influence FO patency, and discusses relevant evidence from both veterinary and human literature. Conclusions Although no clearly documented veterinary case of concurrent PDA and PFO has been identified, comparative evidence suggests that secondary pulmonary hypertension may play an important role in this interaction. Improved understanding of this relationship may enhance diagnostic accuracy and management strategies in neonatal animals.
Amir Mohammad Barati· Veterinary Medicine and Scie...· 0 citations
BACKGROUND
To evaluate cerebral Doppler ultrasonography parameters for predicting hemodynamically significant patent ductus arteriosus (hsPDA) in very premature infants.
METHODS
This prospective cohort study included preterm infants (gestational age [GA] ≤ 30 weeks) who were admitted to a tertiary neonatal intensive care unit. Blood flow velocities, resistive and pulsatility indices of anterior cerebral artery (ACA) were measured at the first 24 and 72 h of life using transcranial Doppler ultrasound. The pediatric cardiologist performed echocardiographic evaluations of all infants at 72 h postnatally.
RESULTS
A total of 77 infants (27 and 50 in the hsPDA and non-hsPDA groups) were included. Mean GA was 27.9 ± 2 and 28.6 ± 1.6 weeks, and mean birth weight was 1056 ± 248 and 1106 ± 269 g in the hsPDA and non-hsPDA groups, respectively; (p = 0.094, p = 0.46). Infants in the hsPDA group had significantly higher pulsatility index and resistive index (RI) than those in the non-hsPDA group at 24 h (p < 0.001 and p < 0.001, respectively). Multivariate analysis revealed that ACA RI above 0.75 at 24 h was an independent predictor for hsPDA.
CONCLUSION
ACA RI measurement may have a potential role, in combination with other clinical parameters, in the early prediction of hsPDA in premature infants; however, further studies are required to validate these findings.
Burak Ceran, E. Dizdar, Rana Beyoğlu et al.· BMC Pediatrics· 0 citations
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