PDA in Preterm Infants Flashcards

Basics

Q: What is the natural history of PDA in preterm infants? A: Many close spontaneously, especially if >1000g; delayed closure common in extreme preterms Tags: pda, natural-history

Q: What is the controversy surrounding PDA management? A: No treatment approach proven to improve long-term outcomes (BPD, NEC, mortality, neurodevelopment) Tags: pda, controversy, high-yield

Q: Is prophylactic PDA treatment recommended? A: NO - not recommended at any gestational age or weight (2025 AAP) Tags: pda, prophylaxis, high-yield

Hemodynamic Significance

Q: What echo markers suggest hemodynamically significant PDA (hsPDA)? A: Ductal diameter >1.5mm or >1.4mm/kg, LA:Ao ratio >1.4, reversed/absent diastolic flow in descending aorta Tags: pda, hspda, echo, high-yield

Q: What clinical signs suggest hemodynamically significant PDA? A: Difficulty weaning ventilator, respiratory support requirements, hemodynamic instability Tags: pda, hspda, clinical

Q: What is the significance of LA:Ao ratio in PDA assessment? A: Ratio >1.4 suggests volume overload from left-to-right shunt through PDA Tags: pda, echo

Medical Management

Q: What is the current standard first-line medication for PDA closure? A: Ibuprofen (similar efficacy to indomethacin but fewer renal side effects) Tags: pda, treatment, high-yield

Q: What is the success rate of pharmacologic PDA closure? A: 50-70% for hsPDA; may require multiple courses Tags: pda, treatment, outcomes

Q: What are the side effects of indomethacin for PDA? A: Renal dysfunction, decreased urine output, NEC risk, GI bleeding, platelet dysfunction Tags: pda, indomethacin, side-effects

Q: What is the role of acetaminophen for PDA closure? A: Emerging alternative, especially when COX inhibitors contraindicated; increasing use in extreme preterms Tags: pda, acetaminophen, high-yield

Q: Can feeding continue during pharmacologic PDA treatment? A: Yes - small-volume feeds (15 mL/kg/day) are safe during treatment; no increased NEC risk Tags: pda, feeding, high-yield

Procedural Closure

Q: What device is approved for transcatheter PDA closure in preterms? A: Amplatzer Piccolo Occluder Tags: pda, piccolo, device, high-yield

Q: How has the trend in PDA closure methods changed? A: Transcatheter: 0% (2011) → 20% (2022); Surgical ligation: 25% → 4% Tags: pda, trends, high-yield

Q: What are indications for surgical ligation of PDA? A: Failed pharmacotherapy, contraindications to medications, hemodynamically unstable Tags: pda, surgery

Q: What complications are associated with surgical PDA ligation? A: Higher morbidity than transcatheter; vocal cord injury, thoracotomy complications Tags: pda, surgery, complications

Management Approach

Q: What is the current approach to asymptomatic PDA in stable preterm? A: Conservative/expectant management is acceptable; many close spontaneously Tags: pda, conservative, high-yield

Q: What factors predict spontaneous PDA closure? A: Birth weight >1000g, older gestational age, smaller ductal diameter Tags: pda, prognosis

Q: What outcomes are NOT clearly improved by PDA treatment? A: BPD, NEC, mortality, long-term neurodevelopment Tags: pda, outcomes, high-yield