How long do you wait before ligating PDAs?

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I'm not looking for general circumstances.... this is related to one case I am working with now.

This kid was a 27 week twin who is 37 weeks corected today. She was only 370g at birth, but has done really well. She's 1.4kg now. She didn't have a murmur (and thus a discovered PDA) until 12/11. At that time, she was on NCPAP (and had been since she was 2 weeks old). Since 12/27, she has been stuck on 6L NP at about 35%. They have tried weaning, but her O2 requirements get too high.

Her twin was ligated a month ago because she was stuck on the vent and was in CHF. She is now on 0.25L NP, nippling great, and about to go home. I know they held off on sending this kid to be ligated because she was on NCPAP. At what point do you say enough is enough? I mean this kid is basically on NCPAP at 37 weeks and can't nipple all because of this PDA. The Neos keep saying they are just waiting for her to get bigger, and hope it closes on its own. How long are they going to wait? It's not like there is a weight minimum on sending kids home anymore...

Ugh... :banghead:

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Specializes in Neonatal ICU (Cardiothoracic).

Symptomatic PDAs get neoprofen x3. If that doesn't work, and they're still symptomatic, then they'll get ligated.

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See, that is what I am used to as well... They are acting as if being on 6L isn't symptomatic! HELLO!!!

Again... I beat my head...

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Specializes in NICU.

The only reason we wait a bit to ligate, is if they're too unstable. Although if they continue to be unstable, then we just do it right at the bedside anyway. They're never going to start getting better when they have a whopping PDA.

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Specializes in NICU.

Yeah, my preceptor has said that surgery will come up to ligate a kid on an oscillator if they need it, since one of my patients is in that direction.

Our protocol is a round of indocin, maybe 2 rounds, then ligation.

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See, this kid didn't have a dx PDA until she was a month old. So... they didn't treat with drugs. They just fluid restricted her and prayed it would close. We are working on a month now, with no improvement. They won't even try diuretics in attempt to get her flow requirements down. The poor kid is dying to nipple and she can't! Her sis is going home next week.

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Specializes in NICU, adult med-tele.

That seems odd. I didn't know there was a time frame on trying Neoprofen. Or maybe there is, I am not as used to that as indocin. Huh. I just looked it up real quick and it is only indicated for infants less than 32 weeks? I know I've given it to babies older than that before.

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Specializes in NICU, PICU, educator.

There is a time frame with ibuprofen, can't remember what it is though. You can use it on the older kids, but it isn't as effective.

We've had a few older kids that had to go for ligation if fluid restriction and diuretics don't help. It really is up to cardiothoracic, but they will take the ones that are symptomatic, if it is a small one then they take the wait and see attitude.

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The baby is 39 weeks now, and was just sent to Children's to be ligated. The twin went home 2 days ago.

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