HJAR Jan/Feb 2020

40 JAN / FEB 2020 I  HEALTHCARE JOURNAL OF ARKANSAS COLUMN CHILDREN’S HEALTH employed in the NICU to deal with a PDA. Surgical correction can be performed at the bedside with a small incision in the back. Surgery provides complete closure of the PDA in nearly all cases, and can be performed without the need for heart/lung bypass. However, this procedure involves a temporary deflation of the left lung in order to visualize the PDA, while also in- terfering with the motion of the chest wall during recovery. Research has shown that in these patients already coping with pre- mature lungs, PDA surgery is associated not only with temporary worsening of their lung disease, but also a prolonged need for mechanical ventilation. An alternative medical strategy uses drug therapy (such as indomethacin, ibu- profen, or acetaminophen) to interrupt the hormone pathways responsible for PDA. While carrying a clear advantage of be- ing non-invasive, this therapy is known to only be effective in 50 percent of preterm infants. In addition, these medications car- ry a significant risk of kidney damage, and have been associated with other problems of brain development, intestinal injury, and bleeding problems. Research also shows that these medications are associated with an increased need for supplemental oxy- gen. As a result of these unsatisfactory out- comes, the recent trend in NICU medicine is toward a third approach: conservative management of the PDA with therapy in- stead directed toward other problems as they occur. At present, more than half of premature infants with a PDAaremanaged conservatively without medical or surgical therapy for closure. With improving ca- pabilities for supportive care in the NICU, the risk of death in the PDApopulation has improved despite the growing popularity of this less aggressive strategy, though the risk of the above mentioned complications continues to be high. In summary, while A Big Problem for Tiny Patients Patent ductus arteriosus (PDA) is a com- mon congenital heart defect encountered in the neonatal intensive care unit (NICU). This condition causes excessive blood flow to the lungs, while also directing this blood supply away from other organs. It is particularly common in smaller infants, affecting almost half of babies weighing less than three pounds. While not as im- mediately life-threatening as many of the more complex congenital heart problems, this defect is known to contribute to the development of other diseases frequently affecting NICU patients, including chron- ic lung disease, injury to the intestine, and brain bleeds. Because of this relationship, preterm infants with a PDA are known to have a risk of death more than six times that of infants without a PDA. An Imperfect Solution Three separate approaches have been AMPLATZER PICCOLO™ OCCLUDER Minimally invasive closure of the patent ductus arteriosus in preterm infants At no bigger than a pea, the Amplatzer ™ Piccolo is one of the smallest heart devices ever. Image Courtesy of Abbott.