Paying attention to and treatment for a heart murmur

Jack Henry has been diagnosed with a heart murmur. More specifically, he has a Patent Ductus Arteriosus (PDA). Although this is common with preemies, this is something that requires diligent monitoring and treatment by the doctors.

Jack Henry's PDA was first noted by the doctors and nurses by listening with a stethoscope during their daily check-ups. The diagnosis of a PDA was confirmed through an echocardiogram.


The ductus arteriosus exists in utero as a means to pass blood between the aorta and the pulmonary artery as the lungs are not used prior to the baby's birth. When a baby is born, often the baby lets out a good scream, followed by a deep breath, which in turn changes the air pressure in the lung. This air pressure change effectively constricts the ductus to be closed. In preemie babies, they may scream at birth like Jack Henry did, but the muscles that line the blood vessels are not strong enough to constrict or stay constricted permanently.

Due to the moderate-to-large size of Jack Henry's PDA, it was not previously detected as the sound to listen to with the stethoscope is the turbulence of the bloodflow passing over the ductus. As the ductus was large, very little to no turbulence (heart murmur) was able to be heard, until recently.

NOTE: I may not provide the most accurate description of this condition, so please click the links in this post.

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Fortunately, Jack Henry has not shown any outward signs of the PDA, such as respiratory problems, inability to take his feedings, or an enlarged heart. The PDA needs to be treated though because the greater risk of congestive heart failure.

The treatment regiment will first consist of dosing Jack Henry with indomethacin. The first course of three doses given 12 hours apart will also require that he be taken off of his feeds (i.e. breastmilk or formula). The indomethacin works to inhibit the production of prostaglandins, which keep the ductus open. Yet, the indomethacin does not act only on the ductus as it also constricts blood flow to the adrenal glands and the kidneys as well as other places. Thus, the doctors will want Jack Henry on only IV fluids and nutrition, while they watch the extent that his urine output declines.

If the first course is unsuccessful or partially successful, the doctors will consider a second course of three doses depending on other factors (i.e. urine output, creatinine level) regarding his tolerance.

After each course of medication, the doctors will perform an echocardiogram to determine the effectiveness of the treatment. Other checks, such as listening with a stethoscope, will be made in between doses for each course.

Finally, if the indomethacin does not solve the issue, the doctors can make an evaluation relative to the size of the PDA. If Jack Henry is performing well, they can continue to monitor his health and the PDA with the hope that the ductus may close on its own or require a lesser invasive procedure when he is older, such as at six months of age. If the PDA requires more immediate attention due to the size and his health, a cardiologist would be brought in to perform a surgical ligation on the ductus (to effectively clamp it closed).

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Lots and lots and lots of 'ifs'.

Elaine and I are praying for success with the medication, but also that this does not cause any other complications or dramatic side effects. While we know that the PDA is common with preemies and that, if surgery is considered necessary, ductus arteriosus ligation is one of the most common performed in the NICU, this is a very anxious time as we watch Jack Henry move through this treatment over the following couple of days.