Ductal Dependent Systemic Blood Flow

Because of the type of heart defect your baby has, their heart is not able to pump blood to their body in the usual way. This means that your baby’s blood flow depends on a blood vessel called the patent ductus arteriosus (PDA). This vessel is present in babies while they are in the womb and usually closes shortly after birth. Your baby will need a procedure to help get blood to their organs and tissues. Until your baby has the procedure, we will give your baby medicine to keep the PDA open.

Before the procedure your baby will have several tests to look at the heart and other parts of the body. This is called a pre-operative evaluation.

These are the tests that will look at the heart:

• Chest X-ray to look at the lungs and the size of the heart
• Echocardiogram/ultrasound (called an “echo”) to find out the exact structure and function of the heart
• Electrocardiogram (ECG) to look at the electrical activity of the heart
• Babies who are born with heart problems can also have problems with other organs.

These tests will look at other parts of the body:

• Renal ultrasound: A bedside scan to look at the structure of the kidneys

There may also be blood tests to see if your child’s heart defect is genetic or related to a syndrome.

Several members of the healthcare team will be involved in evaluating and caring for your child. These include pediatric heart specialists (cardiologists), our pediatric intensive care medicine team (cardiac intensivists, critical care & cardiology fellows, and advanced practice providers), pediatric heart surgeons (cardiac surgeons & advanced practice providers), and other consulting doctors, as needed. Your child will also be cared for by a skilled team of nurses, respiratory therapists, feeding specialists, physical therapists, and social workers.

Because of the type of heart defect your baby has, your baby is very fragile and will need to have a special IV catheter placed to get nutrition and medicine. The most common type of IV is a type of central line (central venous catheter) called a peripherally inserted central catheter (PICC line). It will be placed shortly after your baby is admitted to the hospital or after surgery. Central lines (central venous catheters) are placed in the operating room.

Nutrition is very important for your baby before a heart procedure. However, because of your baby’s abnormal blood flow to the intestines they may not be able to eat by mouth until after the procedure. During this time, your baby’s nutrition will be given through the PICC line with a mix of protein, sugar and fat called TPN (total parenteral nutrition). If your doctor decides your baby can eat, they will be able to have a small amount of milk by mouth. We have a special feeding plan for babies with heart defects. Your nurse will explain it to you.

Your breast milk is very important to helping your baby heal, grow and stay healthy after the procedure. If you are planning to breastfeed, the hospital staff will help you to store your milk to use after the procedure. We will support your baby in learning to breastfeed after the procedure.

For more information about breastfeeding support while you are in the hospital, you can read the booklet “Providing Breast Milk: Your Gift to Your Baby” at seattlechildrens.org/pdf/PE1247.pdf.

To make sure the PDA stays open until the procedure, your baby needs a continuous IV infusion of a medicine called prostaglandin E1 (PGE). The common side effects of PGE are low fevers and fussiness, and it can cause your baby to hold their breath, also known as apnea. Your baby will be watched closely while on this medicine to keep them safe and as comfortable as possible.

Another medicine called furosemide may also be needed before surgery. Furosemide (Lasix) helps to reduce the fluid in your baby’s lungs by increasing urine output.

The team taking care of your baby will be continually adjusting the nutrition, medicines, and breathing therapies to try to optimize your baby’s condition before the procedure.

Some babies with heart defects have problems with their breathing. If your baby needs help with breathing, we have equipment to support them until surgery. Some babies only need a small plastic tube called a nasal cannula in their nose to support them; others may need a machine called CPAP (continuous positive airway pressure). CPAP has a bigger plastic tube connected to high flow air and oxygen. Sometimes, babies need a large plastic tube inserted in their airway that is connected to a ventilator (breathing machine). The doctors and nurses will be continually monitoring your baby’s needs to decide how much breathing support they will need.

The special type of treatments your baby will receive may make it harder to have physical contact with your baby. Bonding with your new baby is very important to us. There are many ways to parent and bond with your new baby even in the ICU. Please ask your baby’s nurse for ideas.

After your baby has some of the tests described above, you will talk with a heart doctor (cardiologist) who will explain the structure of your child’s heart and give you a description of the procedure. You will get regular updates from your baby’s care team, led by the cardiac intensive care unit doctor.

The details of your child’s condition and the plan for your baby’s procedure will be discussed at a hospital conference attended by members of the Heart Center team. Shortly after this conference, we will let you know the date and time of the procedure. Prior to any procedure, the doctor will explain exactly what will happen, and will ask for your consent. This usually happens the day before the procedure.

Your child’s skin needs to be as free of germs (bacteria) as possible before their procedure. Thoroughly washing the skin with Sage 2% chlorhexidine gluconate (CHG) wipes can greatly reduce the number of germs and help us prevent infection. Your child will have a bath using these wipes the 2 nights before the procedure and the morning of the procedure.