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What Do We Know About Patent Dustus Arteriosus - Dr. Adhi Teguh, Sp.a (K)
What Do We Know About Patent Dustus Arteriosus - Dr. Adhi Teguh, Sp.a (K)
Oxygen
Endothelin
Calcium channels Do not
Favor
Catecholamine ductal
Rho Kinase closing
PVR>SVR
LA dilatation
diastolic shunting in distal Aorta
Increase LV preload LV diastolic pressure ↑
Increase LVO
Coronary perfusion↓ Retrograde diastolic flow in distal Ao
Poor LV compliance & contractility
Ductus Pulmonary
Gastrointestinal
Arteriosus over flow Lung hemorrhage
track and kidney
Qp
Lungs
Skin, bone, Lung edema
Qs
skeletal muscle
Body Semin neonatol.2001;6:75-84
INDONESIAN PICU NICU UPDATE – 2020/2021
Compensation of hs-PDA
Lung overflow
• Increase mean airway pressure by grunting, nasal flaring, work of
breathing etc.
Increase LA volume
Increase LV end diastolic volume
Increase LV filling pressure
Increase LV sphericity index
Increase LVO
Pulmonary Pressure
Symptom of PDA
L→R PDA shunt
L→R PDA shunt
Hipotension
Pulmonary Hemorhage
IVH
BPD/NEC
The clinical sign of PDA are generally apparent
beyond the first natal week but lag behind
Evan N et al. J Pediatr Child Health. 1994;20(50);406-11
Echo diagnosis by nearly 2 days
INDONESIAN PICU NICU UPDATE – 2020/2021
Clinical Signs of hs-PDA
• Continuous or systolic murmur
• A low diastolic blood pressure
• A wide pulse pressure (due to ductus runoff or steal)
• Hypotension (especially in the most premature infants)
• Tachycardia & Precordial hyperactivity
• Bounding pulses
• Increased serum creatinine concentration or oliguria
• Hepatomegaly
• Pulmonary edema → tachypnea, decreased SpO2 , and
increasing respiratory support
Score > 2 → do the
• Lactic acidosis Echocardiography
Krakauer et al. Neoreviews. 2018 July ; 19(7): e394–e402. Kindler A. Frontier in ped.2017;5:280-5
INDONESIAN PICU NICU UPDATE – 2020/2021
Blood Pressure and hs-PDA
Age in Systolic Diastolic Mean (Calculated)
weeks
Highest Mean Lowest Highest Mean Lowest Highest Mean Lowest
24 14168 infants
49 at a
33 mean46 (SD)29gestation
14 and
53 36 20
25 69
birthweight51 of 26
36 (1.4)
47 weeks
30 and15 952 (235)
54 g37 22
26 70 52 38 48 31 17 55 38 24
27 71 54 40 49 32 18 56 39 25
28 72 55 41 50 33 19 57 40 26
29 73 56 42 51 34 20 58 41 27
30 75 59 43 52 35 21 60 43 28
31 78 61 46 53 36 22 61 44 30
32 80 62 48 54 37 23 63 45 31
33 81 63 50 55 38 24 64 46 33
34 83 66 51 56 39 25 65 48 34
35 84 69 52 57 40 26 66 50 35
36 87 71 55 58 41 27 68 51 36
37 89 72 57 59 42 28 69 52 38
38 90 75 59 60 43 29 70 54 39
39 91 78 60 60 44 30 70 55 40
40 92 80 61 61 44 30 71 56 40
Permissive limiting FiO2 increase PEEP Keep Ht > 45% Avoding blood loss
hypercapnia
Paracetamol
- Prostaglandin G2
POX + Hydroperoxidase
From leucocyte,
Prostaglandin H2 Thrombocyte