PDAs: STEP-by-STEP explanation// symptoms// signs// treatment!

Everything you need to know about PDAs explained so you will understand and retain the information forever! Anatomy, physiology, signs and symptoms, echo and Xray findings and then treatment and management strategies.
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Please be sure to give us a like, comment about future topics, and subscribe to this channel to stay up to date on all things NICU! Also, click the notification bell after you subscribe to gain your weekly NICU knowledge as soon as it's loaded!
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Dr. Tala is a board-certified neonatologist, and has worked in busy level III and IV units for the past 15 years. She has won multiple teaching awards throughout her time as a neonatologist.
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**TIMESTAMPS**
00:41 Intro
00:55 Anatomy and physiology of a PDA
8:12 Signs and symptoms of a PDA
14:05 ECHO (and x-ray) findings of a PDA
18:55 Treatment and management strategies of a PDA
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Brenton R R, J Radha K, Robert A. The Role of Surgical Ligation of Patent Ductus Arteriosus in Very Preterm Infants: A Mini Review and Case Report. Acad J Ped Neonatol. 2016; 2(4): 555591
(used with written consent from Dr. Brenton Robinson)
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Music: www.bensound.com (royalty free with credit)
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*Disclaimer*: This video is intended for educational purposes only and while
we strive to give the most accurate information, errors may occur. Subsequently,
this video should not be a replacement for medical advice.

[@inalumieresonia9677]

I love the way she explains things so clearly.she is now my online mentor in neonatology.

[@TalaTalksNICU]

Thank you so much! We really appreciate your lovely words!

[@inalumieresonia9677]

You are welcome!

[@kyleFed]

Same. 😂

[@Unknown-cw1jz]

And i love the way she laughed between lecture 😂

[@aniponi1998]

Dear Dr Tala! I have just passed my OSCE of QIS! I wanted to thank you a lot, as your videos really helped me to understand neonates. One of my questions was PDA, and thanks for your clear explanation I did very well :) Please, keep doing those videos, as we all still need to learn a lot :) With lots of love: Aniko from U.K. :)xxx

[@TalaTalksNICU]

Congratulations Aniko! Thanks so much for sharing the great news with us- and for watching our videos! We have no intention of stopping- especially when we get comments like yours :)

[@jill2330]

Watching these videos from the Yukon! Thanks a bunch! Extremely informative and helpful, keep it simple to deal with the complex. Working as a CCP up north, we've got new neo/OB transport capabilities and these lectures have really helped me feel less intimidated! Cheers!

[@TalaTalksNICU]

Hello Jill!!! Thanks so much for watching and commenting and subscribing! I looked up where the Yukon is (had this vague notion it was North- but wasn't sure where!)- so now I know! Must be absolutely beautiful there. I'm sure the weather and the geography bring a whole bunch of transport issues too- but must be a much needed service! Thank you again- hope you're enjoying some of the holiday :)

[@nimtramfournier]

The most complete and easy training I have attended so far! Great job!

[@TalaTalksNICU]

Thank you so much Martin -for watching and for commenting :)

[@reinabolanos2127]

Thank you SO much for posting and explaining this topic so easily. A new subscriber, and a new NICU nurse here trying to learn as much as possible!

[@TalaTalksNICU]

Oh yay! That makes us so happy- really glad that it helped you. And thank you so much for subscribing too!! Let us know if there's anything else you'd like us to cover!

[@nicurn5030]

WOW!ANOTHER WINNER! THank you DR TALA!

[@TalaTalksNICU]

You are just the best! Thank you NICU RN :))

[@drmohammadiqbal1690]

Excellent way of conveying knowledge. A lot concept are cleared at this stage of life.

[@TalaTalksNICU]

Oh thank you so much- what a lovely comment!

[@jenniferbrown202]

Absolutely love your videos! Thank you so much for sharing your wealth of knowledge!

[@TalaTalksNICU]

Oh thanks so much Jennifer! We are so happy that these are at all helpful. We are working on the idea quality now!!! Thanks!!

[@areeba614]

wow you make me fall in love with nicu. You answer my questions even before I've had the chance to voice them. thank you!

[@TalaTalksNICU]

Literally our favorite comment! We want everyone to fall in love with the NICU! Thanks so much for watching these videos and for taking the time to comment :)

[@niculactationeducation]

Wow!! Thank you. That was great! You are the best teacher I have ever heard. I plan on watching all of your videos and I have worked in the NICU for 29 years!! Your nurses are so lucky to have you.

[@TalaTalksNICU]

Well that could be my favorite comment ever!!! Thank you SO much. I think I've had a bit of a black cloud recently so I'm not sure how happy the nurses are that I'm there! ha! Thank you again. 29 years :) happy times!

[@mariaaudu3898]

Wow! Thanks very much Dr Tala. Indeed l understand PDA much better now. The video was worth watching . Looking forward to more videos on congenital heart disease. Thanks 😊 again

[@TalaTalksNICU]

That makes us soooo happy!! Thank you! We promise the heart diseases are coming!!!!

[@bwalyatubi6814]

Wow wonderful explanation. Keep doing what you're doing👏🏾🙌🏾 from Zambia🇿🇲

[@TalaTalksNICU]

That is so fantastic that you're watching from Zambia. That makes us so happy! That this channel allows us to interact with like-minded people from all over the world. Thank you for watching and for commenting!

[@rks5483]

This was a great refresher, thank you!!

[@TalaTalksNICU]

So glad you think so Rachel! Thanks so much for watching :)

[@amaranathl9864]

You have great talent of explaining subject in a story telling with logic expalantions .great i Appreciate your way of teaching TALA

[@TalaTalksNICU]

This is such a lovely comment- it’s something I’ve worked hard on so it means so much that you mentioned it! Thank you!!

[@melanieroberts72]

I’m a first year nursing student and watch your video for a better understanding of PDA. Very helpful! Thank you.

[@TalaTalksNICU]

SO glad you found this helpful! Good luck with your classes- so impressed you're supplementing you education already!

[@cynthiaakram8432]

Thank you so much Tala !!! You and your team are NICU angels :) From your Canadian HCP Fans

[@TalaTalksNICU]

Thank you so much Cynthia! What does HCP mean though?! Love learning new terms! ha!

[@cynthiaakram8432]

Health Care Provider :)

[@TalaTalksNICU]

OF COURSE! Sorry!!! Thanks though!!

[@user-kf9ke5jj5u]

Following the lecture from Nairobi Kenya explanation of PDA made simple thank you.

[@TalaTalksNICU]

So happy! That's a bucket list place for me- thank you for commenting!

[@tiffanypaz8484]

omgosh this video explained everything i have always wondered about my time in the NICU! i was adopted out 38 years ago as a very tiny tiny newborn baby. i was born 22 weeks prematurely back in 1984. i was told i had a PDA done a type of heart operation but never fully understood was it was or how it was done or why. i have a big long scar running all across my left side of my body under my arm. i also have damaged vocal cords which now makes me sound like i am sick or something. i have a low, soft, raspy speaking voice. wow,thank you ma'am for your video,your awesome!!!!!!! 💗

[@TalaTalksNICU]

Oh wow Tiffany- that's crazy! a 22 weeker nearly 40 years ago! What a strong fighter you must have been. SO glad this helped in any way! Thank you for watching and for taking the time to write! Are you in the medical field at all now?

[@user-df9jr4lz6m]

She is the best I now understand easily the nnicu diagnosis and problems

[@TalaTalksNICU]

So so happy that these videos allow you to understand everything easily!!!! Makes everything more fun!

[@osamaalagamawy3891]

This very marvelous presentation.

[@TalaTalksNICU]

Glad you think so Osama:)

[@ninjhanice8134]

finally Cardiac case. Thankyou Ms tala😍

[@TalaTalksNICU]

Thank you Nurse Janice! There will be a whole series soon!!!

[@blueyedangora]

Thank you so much for all your videos Dr. Tala!Hope You keep making videos about NICU topics.

[@TalaTalksNICU]

Thank YOU Jo for watching and commenting! Words like yours definitely keep us going!!! Thank you :)

[@tonymorre5264]

These videos are so great! You make these topics very easy to understand. Thank you Dr Tala!

[@ioanavieru144]

Thank you for the clear explanations! I don't have a medical background, I'm a parent of a premie with a PDA and watching your video I understand what the doctor evaluates at each consult.

[@TalaTalksNICU]

Congratulations on your baby! So glad the video helped. Impressed you're watching medical information. We really hope your baby is doing well :)

[@ioanavieru144]

@@TalaTalksNICU Thank you! She is fine, she is already 4 years old.

[@VladFamily10]

Thank you for very detalied explain❤

[@TalaTalksNICU]

Thank you so much for being here- so happy it helped at all!

[@gaganbajaj4035]

Your videos are super informative as well as simple Love watching them Suggest you to make a video on PFO

[@TalaTalksNICU]

Thank you so much for watching and for the comment! We did not have a discussion about PFOs on our list so we will definitely add that! (Important too!)

[@gretchenmann633]

I love this. Thanks.

[@TalaTalksNICU]

We're so happy! Thanks for taking the time to comment :)

[@stillbreathing100]

Excellent !!esp the point that Preductal and postductal are the same in PDA as opposed to pphn and the echo findings (Qp : Qs / LAH) Thanks

[@TalaTalksNICU]

We love you Awais! Thanks so much for all your lovely comments! Thanks so much :)

[@danielavalenzuela4616]

Hi! I love your talks! I would love if you could do one of apneas and/or BPD

[@TalaTalksNICU]

Hello Daniela! Thank you for watching and for your excellent suggestions. We will be doing BPD soon- and then apnea will follow. I wish we could get these out faster- but we're all too busy!! Thank you again!

[@platypusary]

Thank you so much Tala and team. Wondering if you could cover HFOV basics?

[@TalaTalksNICU]

Hello! Thanks so much for watching! We're getting around to a HFOV video- we promise!! To follow after a jaundice series!!!

[@ungsopheap3955]

Good explaination professor.

[@TalaTalksNICU]

Thank you so much- appreciate you being here!

[@adetokunboakinseye3666]

Hi Dr. Tala, thanks for the comprehensive explanation. Could you please review neonatal parenteral nutrition and electrolyte imbalance. Thank you.

[@TalaTalksNICU]

Yes! Thanks so much for the suggestion- we will definitely be running a few videos on TPN/ fluids and electrolytes!

[@hossamyasser8651]

Thank you so much, Dr. Tala.

[@TalaTalksNICU]

Thank you so much for watching all of these :)

[@mohammedmaheer4740]

Excellent

[@TalaTalksNICU]

Thank you so much Mohammed :)

[@asnfhtmlzxsje274]

If the circulation is not duct dependent I use medical management for sure. Though it might close by its own. Early closure of ducts helps in relieving respiratory distress and helps in early discharge. We use Actitomenophene as first line drug.

[@TalaTalksNICU]

That's a tough one. If the patient is on 21%, tolerating feeds, growing and with no other issues, it's very difficult to rationalize giving any medications. Institutions and providers all practice slightly differently.

[@essamelabagy2838]

excellent presentation

[@TalaTalksNICU]

Thanks so much Essam! Really appreciate your lovely comment :)

[@hraqhraq]

It took me a while to recognize that the word she said "mama" was actually "murmur" This is an excellent lecture otherwise She didn't mention blood pressure of measurements you could expect or the pulmonary trunk pressure drop during the first 3 days after birth

[@TalaTalksNICU]

Ha! My accent! sorry! It's a weird mix of many accents at this point!! Great points that we maybe didn't emphasize enough! Thanks for watching and for commenting :)

[@jawairiakhan9995]

Amazing 🥰

[@TalaTalksNICU]

So happy you're watching a few of these- best compliment we can be given! That you want to watch more :)

[@ramalingamkc2153]

Thank u madam for a simple and lucid presentation

[@TalaTalksNICU]

So happy you find it helpful! Thanks so much for watching and taking time to comment!

[@charl702]

As a non medical person this was really helpful learning session ❤

[@TalaTalksNICU]

Thank you so much! Impressed you’re watching as a non medical person!!!

[@jonathanmesa9790]

Thanks for this very concise explanation!. Do you have another video on TOF?Watching from🇵🇬.

[@TalaTalksNICU]

Hello Jonathan! Thank you for watching and for taking the time to comment! We are planning on a cardiac series soon- starting with Tets- hopefully before end of summer here! I had to look up your flag- I didn't recognize - but so happy you're watching all way from Papua New Guinea!!! Thank you :)

[@Mohi7-]

Respect 👏

[@TalaTalksNICU]

Thanks so much Mohamed :)

[@Blue-gs5gg]

Love tala mam..

[@TalaTalksNICU]

What a lovely comment! Thank you!

[@mekawwi]

Greetings from Toronto

[@TalaTalksNICU]

Hi!!! Love Toronto! So glad you’re watching from there! Thanks for being here :)

[@osamaalagamawy3891]

ما شاء الله. بارك اللة فيكم

[@TalaTalksNICU]

THANKS

[@mans12341000]

As usual its been informative and excellent contents. Could you please try to make video on TPN also management part of jaundice video series is pending. Thanks a lot.

[@TalaTalksNICU]

Hello! Love your handle by the way! We are publishing the treatment of jaundice next - and then there will definitely be a series on TPN and electrolyte imbalances. Thanks so much for watching and for your suggestions :)

[@sinclair657]

Thank you

[@TalaTalksNICU]

:)

[@Majdzoni]

Wow !

[@TalaTalksNICU]

Hope that's a good wow!!!

[@ruthviadriana5678]

thank you

[@TalaTalksNICU]

Thanks for watching!

[@Jo-mp3qo]

Just 😍

[@TalaTalksNICU]

Thank you Jo T!

[@219gm]

Thanks for easy to understand presentation. I want to know your opinion about prophylactic use of ibuprofen in PDA.

[@TalaTalksNICU]

Thank you for watching and taking the time to comment. We don't use prophylactic ibuprofen in our unit. This is the most recent Cochrane trial that investigates this: pubmed.ncbi.nlm.nih.gov/31222841/ Do you do this where you are? Editing to add- I just saw this article- I’m guessing you were referring to this? Kim CY, Chung SH. Single-dose prophylactic ibuprofen therapy for patent ductus arteriosus in preterm infants. Medicine (Baltimore). 2022 Aug 5;101(31):e29915. doi: 10.1097/MD.0000000000029915. PMID: 35945745; PMCID: PMC9351839.

[@goecmj]

If you do another "potpourri" one, would you include there how you keep track of all the variability in what is and isn't acceptable blood pressures depending on gestational age? At what point (looking at BP only) should we start thinking pressor support vs watchful waiting? Thank you for all that you do!

[@TalaTalksNICU]

This is such a great question JH! We did a blood pressure nugget on widened blood pressures (eg twice diastolic < systolic is wide). A lot of people use the ballpark of gestational age ~ mean arterial pressure. But this is also overly discussed. At bedside the most important thing is how does the baby look like? Good perfusion, pink, active, good pulses, normal HR, good UOP? These should guide us as much as BP. Sometimes trying to improve a borderline BP is worse than just watching it (eg fluid blouses, dopamine etc). So honestly I think the answer would be looking at the full picture- and using GA as a very rough guide!!!

[@goecmj]

@@TalaTalksNICU thank you so much for your reply! Very much appreciated!

[@nicolechino3554]

Preemies that are vented and have a large PDA usually have dramatic swing in Saturations. Is this because you’re loosing oxygenated blood to the ductus? Also, if giving PRBC to keep hct up help with the swinging of sats?

[@TalaTalksNICU]

Hello Nicole, that is a great question. Most likely it is because most of the blood is going to the lungs through the ductus, greatly deceasing the perfusion to the extremities. In this way- giving blood would probably improve Oxygen carrying ability. I def try to keep hct higher if there is a significant PDA.

[@MJ-mz7us]

Awesome video.. Really very helpful. Can you please make one on DAART or Hydrocortisone please.

[@TalaTalksNICU]

Hello MJ- thanks so much for your lovely comment. We haven't made a specific video on steroids- but we discuss steroids and their treatments extensively in the second BPD video (treatment of)- if you want to go check that out (and we include the relevance of the DART study in there). hope that helps?!

[@MJ-mz7us]

@@TalaTalksNICU Thanks i am going to watch it now. But your videos are really awesome. Keep posting it. Also it would be great if you can discuss some x-rays too as you really teach very well.

[@TalaTalksNICU]

Yes MJ! I love this plan- a video on just X-rays. We’d been putting it off before because we were concerned about copyrights on CXRs- but we’ve realized with correct crediting we’re allowed to use them! Thank you!

[@miguelassan2386]

My baby was born on march 10/2022 with 22 weeks a very small and premature baby weighting 1 pound and 5 onz. He was also burn with a problem in his skin but thanks to Dr. George M Varkarakis my babe skin has been healed. Today April 12/2022 he was taken to the PDA plug procedure and It was a success thanks to the Dra. Prieto and her team at the Nicklaus Children's Hospital in Coral gable,FL. But also I want to thanks Dr. Eduardo Valdez from Mercy Hospital in Miami, and Dr. Bello from Baptist Hopistal in kendall, FL they did a wonderful job helping my wife with support and helping her to give a successfully birth. All glory to the Almighty God 🙏🏼 🙌🏼

[@TalaTalksNICU]

WOW! Thank you so much for sharing your baby's story. We wish you luck and health for your son's future :)

[@cherylrajewski3390]

At CHLA they use Acetaminophen as a medical management for a lot of the cases of PDA.

[@TalaTalksNICU]

Many places still do/ probably not quite as effective as NSAIDS but can give enterally and feed through and not as many side effects. Wish we all had a better idea of what to do with PDAs!!!

[@britneywebster2669]

Hello! Thanks so much for the video. Is the QP to QS ratio similar to the LA to AO ratio?

[@TalaTalksNICU]

This is a great question Britney. Basically both parameters are trying to predict how bad the left to right shunt is, but they measure different things. Qp/QS is a measurement of flow. (Q stands for flow). So it measures (or estimates) the amount of blood going to the lungs as opposed to the blood going to the body. So for example there's a large PDA, and half of the blood leaving the aorta actually goes to the lungs (in addition to all the blood coming back from the body)- so the Qp/Qs ratio here would be 1 + 0.5/0.5 or 1.5/0.5 so 3:1. This would be horrendous! But I'm trying to make the point!! The LA/ao ratio is a measurement of length. So if loads of extra blood is going to the lungs, loads of blood will be leaving the lungs. Where does that blood go? To the left atrium. So if the left atrium is enlarged (compared to the 'width' of the aortic root- which should stay pretty stable), then you can assume that the heart is stressed because of all that extra blood filling the left atrium. Does that make sense??

[@britneywebster2669]

Yes it does, thank you!

[@mariaaudu3898]

Please how do I get to the community channel? Would love to answer the multiple choice questions. Thanks

[@TalaTalksNICU]

Hello Maria! I think you have to be on the app or on an actual computer to access the community tab. But if you go to the home page- it’s one of the tabs there. Let us know if you found it!!!

[@purnimakumari4341]

Kindly make video on neonatal shock...

[@TalaTalksNICU]

Hello! We definitely need to do this! We got quite behind with requests- but I'm very excited to talk about this one! Thank you for your great suggestion!

[@dmitripanov9980]

At the end of the talk you say that the bigger the baby is the easier the procedure is. I wonder, is there optimal age for doing PDA occlusion for a child, in case PDA is small

[@TalaTalksNICU]

Urgh- I think we should get a cardiologist to talk more about this process. Because I think that was too much of a generalization!!!! Sometimes the ducts are too big to close!! And different anatomy can affect how easy it is to close. Generally though the bigger the baby the easier to access the ductus at least!

[@murwaayoub9819]

Hi there i would love for you to let me kkow your thoughts, my son who was born full term at 38 weeks and 2 days and is currently 4 months old has been found to have PDA and the measurment is 1mm, cardiologist said that he expects it to close as the great artieries grow and close it, he wss asymptomatic so no symptoms, he is 7.2kg and is feeding well, but i do see that he pulls away from the bottle when i give it to him he is exclusively breast fed, also he started to sweat a few times whilst feeding but the cardiologist said he can not put it to the 1mm PDA. CAn you let me know what your opinion is on this matter and if he is thriving snd gaining weight and doesnt have any further issues should i do the wait it out game?cardiologist also said that there is a very quiet murmur that he was able to hear. Do let me know please as i am extremely stressed out because of this

[@TalaTalksNICU]

Hello! Sorry taken a few days! It sounds like the cardiologist is completely on top of this and I’m sure they know details much better than me! 1mm is pretty small for a 4 month baby. The symptoms we would see from a concerning pda would be breathing fast and not gaining weight. Sounds like he has neither of those- and so based on everything you’ve said I’d wait it out and see if it closes by itself.

[@doctormombaby4319]

Want to know more about Neonatal sepsis

[@TalaTalksNICU]

Hello! yes- we definitely need to get around to this. This will definitely be a 2022 topic! Thanks for subscribing and for watching :))

[@hannahng4161]

If pregnant women shouldn’t take ibuprofen because it can close the DA in utero, would you say that pregnant women shouldn’t take acetaminophen either? Thank you!

[@TalaTalksNICU]

Hi Hannah! Great question! So really the biggest risk for closure of the PDA (for ibuprofen etc) is after the third trimester. Earlier it can affect kidney function in the fetuses though- so never a good idea. Tylenol does not seem to be associated with early closure of the DA- which I can’t explain. Maybe the dose isn’t high enough? Interestingly recent studies do suggest there may be a relationship between Tylenol intake and behavioural problems..

[@melaniepaqui173]

How about a lecture on NEC?

[@inalumieresonia9677]

Yea NEC would be great

[@TalaTalksNICU]

We promise Melanie and Inalumiere we are getting to NEC! We got quite behind with requests- but there will be two lectures on NEC (pathophysiology and prevention, and then diagnosis and treatment). These all take longer than we thought they would (and Arianna is a perfectionist :))

[@inalumieresonia9677]

Thank you so much.

[@Unknown-cw1jz]

Mam i wasn’t clear about the pre and post ductal saturation is my class teacher told me that this happened and you said it’s not happen he said that the post and preductal saturation differences will occur Confused 😒

[@TalaTalksNICU]

If the shunting is left to right there won’t be a ductal difference. If the shunting is right to left there will be! Go watch PPHN video too- that may help?

[@Unknown-cw1jz]

@@TalaTalksNICU ok mam thank you so much I’m BSN 5th semester student enjoying your lecture lots of love from Pakistan 🇵🇰

[@jampellhendrup1376]

At what age can this infant with PDA go for surgery. What is the drug of choice for PDA

[@TalaTalksNICU]

Great questions Jampel! In the hands of a good surgeon- there is really no baby too small for a PDA ligation (they can do them on jets or oscillators on 700g babies). And there is no real 'drug of choice'- historically we have used indomethacin, or more recently ibuprofen. Now more institutions are using acetaminophen (Tylenol)- which may be slightly less effective, but has the added advantage that we can give it enterally and feed through the course. Does this answer what you wanted to know?

[@jampellhendrup1376]

@@TalaTalksNICU thank you for the answer Dr. Thank u for the wonderful answer 😚💗

[@shalikabandara5254]

What about the oral Acetaminophen for PDA?

[@TalaTalksNICU]

Oooh great question! It hasn’t been shown to be as effective as nsaids but it’s still probably better than nothing- and you don’t have to stop feeding infants while they’re on it! Wish we had better answers about pdas!!!!

[@shalikabandara5254]

In our setup use paracetamol for pda than nsaids.

[@ramalingamkc2153]

Thank u madam for a simple and lucid presentation

[@TalaTalksNICU]

You are most welcome

[@sinclair657]

Thank you

[@TalaTalksNICU]

Thank you so much for watching )