Development of a Diagnostic Clinical Score for Hemodynamically Significant Patent Ductus Arteriosus

Abstract

There is no consensus about the hemodynamic significance and, therefore, the need to treat a persistent ductus arteriosus in preterm newborns. Since the diagnosis of a hemodynamically significant persistent ductus arteriosus (hsPDA) is made by a summary of non-uniform echo-criteria in combination with the clinical deterioration of the preterm neonate, standardized clinical and ultrasound scoring systems are needed. The objective of this study was the development of a clinical score for the detection and follow-up of hsPDA. In this observational cohort study of 154 preterm neonates (mean gestational age 28.1 weeks), clinical signs for the development of hsPDA were recorded in a standardized score and compared to echocardiography. Analyzing the significance of single score parameters compared to the diagnosis by echocardiography, we developed a short clinical score (calculated sensitivity 84% and specificity 80%). In conclusion, this clinical diagnostic PDA score is non-invasive and quickly to implement. The continuous assessment of defined clinical parameters allows for a more precise diagnosis of hemodynamic significance of PDA and, therefore, should help to detect preterm neonates needing PDA-treatment. The score, therefore, allows a more targeted use of echocardiography in these very fragile preterm neonates.

Echocardiographic Prediction of Left Ventricular Dysfunction After Transcatheter Patent Ductus Arteriosus Closure in Children

“…Echocardiography is the most common diagnostic method that provides information regarding PDA size and hemodynamics, and it is also the most frequently used method for the evaluation of cardiac chamber size and LV systolic performance (10). Moreover, these parameters obtained by echocardiography correlate well with those measured during cardiac catheterization and radionuclide angiography (11, 12), and the possibility of the use of echocardiographic parameters in risk assessment for adverse cardiac events has been proven in recent studies (13–15).…”

Morbidity Associated with Patent Ductus Arteriosus in Preterm Newborns: A Retrospective Case-Control Study

“…The enrolled subjects were divided into 2 groups according to the presence (Cases) or absence (Controls) of a hemodynamically signi cant PDA (hs-PDA), con rmed by echocardiographic evaluation. We de ned PDA, as hemodynamically signi cant, when we observed at least one of the following criteria: 1) PDA diameter at its narrowest part ≥ 1.5 mm; 2) unrestrictive pulsatile transductal ow; 3) left atrial-to-aortic root ratio ≥ 1.5; 4) absent diastolic ow in descending aorta; 5) abnormal diastolic ow in middle cerebral artery [5,[12][13][14]. Newborns were classi ed as Cases when affected by hs-PDA, con rmed by echocardiographic evaluation performed within 1 week of life.…”

Morbidity associated with Patent Ductus Arteriosus in Preterm Newborns: A Retrospective Case-Control Study

“…3) absent diastolic ow in descending aorta; 4) abnormal diastolic ow in middle cerebral artery [5,[12][13][14]. Echocardiography (ECHO) was routinely performed by cardiologists trained in neonatal functional ECHO between 24 and 72 hours after birth, in all premature infants admitted in NICU.…”