In a premature infant with hyaline membrane disease and inability to be weaned from mechanical ventilation, which of the following would suggest hemodynamically significant patent ductus arteriosus (PDA)?

A. Continuous murmur.

B. Hyperactive precordium with bounding peripheral pulses

DISCUSSION: PDA causes a left-to-right shunt that produces left ventricular volume overload. Physical findings include evidence of hyperdynamic circulation with a prominent apical impulse and bounding peripheral pulses. The classic murmur of PDA is a continuous or mechanical murmur heard over the precordium and radiating to the medial third of the clavicle. Diminished femoral pulses are not seen with isolated PDA and would suggest other anomalies. PDA may result in hepatomegaly but does not cause jaundice.