PATENT DUCTUS ARTERIOSUS /PDA/ COMPLICATING THE “RESPIRYTORY DISTRESS SYNDROME” /RDS/

The role of PDA in the pathogenesis and course of RDS has been debated for many years. As more intensive pulmonary care is given to preterm infants, heart failure from PDA has been increasingly recognized. In 50 preterm infants with RDS /B.W.600–2100 gms, and G. A. 25–34 wks/ the patency of ductus arteriosus was established by single film aortography or by clinical signs and confirmation at surgery. In 14 infants, cardiomegaly and heart failure with massive left-to-right ductal shunt occurred before the appearance of heart murmur. Fourteen infants had severe and 36 mild to moderate RDS. Massive cardiomegaly occurred, significantly earlier in infants with severe RDS. /2.5±0.6 vs 10.8±2.3 days/ and hence, ligation of ductus performed sooner in the severe RDS group /8.1±1.7 vs 15.40±2.5 days/. It is suggested that ductal ligation is indicated when an infant with severe RDS and cardiomegaly requires intermittent positive pressure ventilation and whose retrograde aortogram shows massive left-to-right shunt. In infants with mild to moderate RDS and PDA surgery is indicated only when respirator assistance is required to control apnea and pulmonary edema.