2026 Annual Meeting, presented by IARS and SOCCA

This preterm neonate presenting for repair of an omphalocele has a widened pulse pressure, tachycardia, and tachypnea despite fluid therapy. The patient’s continuous machinery-like murmur is indicative of a patent ductus arteriosus (PDA). The ductus arteriosus is a remnant of the fetal circulation, and connects the aorta to the main pulmonary artery. It usually closes shortly after birth, but may remain open, accounting for 10% of congenital heart disease cases. PDA is common in preterm neonates and leads to overcirculation of blood flow to the lungs (left to right shunting). For patients with PDA, placement of the pulse oximetry probe is particularly important. Preductal (prior to the ductal opening) oxygen saturations are more representative of the oxygen saturation seen by the brain and the coronary arteries while postductal (after the ductal opening) placement reflects the oxygen concentration delivered to the distal tissues. Preductal oxygen saturation can be obtained on extremities receiving blood from vessels located proximal to the ductus including the right hand and both ears. Postductal measurements are obtained on the left hand or either foot. Ideally both preductal and postductal oxygen saturation are monitored; however, if only one saturation probe can be used, preductal saturations are preferred for monitoring oxygen delivery to the brain.