PDA Hemodynamics
Significance scoring & closure options
Educational decision support only. This is not a medical device or substitute for clinical judgment. Always confirm with your unit's protocol and applicable guidelines before clinical action.
Patient & Echo
Assessment
Score 10/13
Hemodynamically significant PDA (hsPDA)
Strong indication to consider treatment, especially if preterm, ventilated, or failing to progress.
- Large PDA (2.5 mm/kg ≥ 2.0)
- LA:Ao 1.6 ≥ 1.5 (LA dilation)
- Diastolic flow reversal in descending aorta
- Left-to-right shunt
- Invasive ventilation
Medical closure options
Weight-based dosing for a 1.000 kg infant. Confirm renal function, platelets ≥ 60k, and absence of active bleeding, NEC, or significant right-to-left shunt before COX inhibitors.
Ibuprofen (IV) — Neoprofen
10.0 mg IV × 1 (10 mg/kg)
then 5.0 mg IV q24h × 2 doses (5 mg/kg)
Preferred over indomethacin in most units — less effect on renal, mesenteric, and cerebral blood flow. Second course acceptable if PDA persists and remains significant.
Ibuprofen (PO) — high-dose regimen
10.0 mg PO × 1 (10 mg/kg)
then 5.0 mg PO q24h × 2 doses (5 mg/kg)
Reasonable when IV access is limited and gut is otherwise stable. Some evidence for higher closure rate with 15–7.5–7.5 mg/kg regimen in ELBWs.
Indomethacin (IV)
0.20 mg IV q12h × 3 doses (0.1–0.25 mg/kg/dose; use 0.2 shown)
Also used for IVH prophylaxis in first 24h in some units. Higher risk of oliguria, SIP, and reduced cerebral perfusion vs ibuprofen.
Acetaminophen (paracetamol)
PO: 15 mg q6h × 3–7 days (15 mg/kg/dose)
IV: 15 mg q6h × 3–7 days
Reasonable when COX inhibitors are contraindicated (renal dysfunction, thrombocytopenia, NEC, IVH concern). Monitor LFTs with prolonged courses.
Conservative / supportive measures
- Fluid restriction toward 120–130 mL/kg/day if significant shunt and adequate nutrition tolerated.
- Optimize PEEP (≥ 5–6) to reduce left-to-right shunting.
- Maintain hematocrit ≥ 35–40% in symptomatic infants.
- Avoid excessive diuretics — furosemide increases PGE₂ and may maintain patency.
- Reassess with echo before repeating or escalating treatment.
Educational tool. Verify all dosing against your unit's protocol and current formulary. All calculators →