Echocardiographic assessment of intimal thickness growth of patent ductus arteriosus in neonates and analysis of influencing factors

Abstract

The spontaneous closure rate of patent ductus arteriosus (PDA) is high, and the necessity of early intervention is debated. Quantitative echocardiographic assessment of the intima in PDA has not been reported. This study evaluated intimal thickness growth in neonatal cases of PDA via echocardiography and investigated its correlation with clinical factors. Seventy-three neonates were enrolled, and echocardiography was performed three times: within 24 h post-birth (first echo), 48 h after the first echo (second echo), and before discharge (third echo). According to PDA outcome, the neonates were divided into the PDA-open group (n = 18 cases), PDA-closure at second echo group (n = 32 cases), and non-PDA at first echo group (n = 23 cases). We measured the intimal thickness (IT1 and IT2 at first and second echo, respectively), lumen diameter of ductus arteriosus (D1 and D2 at first and second echo, respectively), IT1/D1 ratio, and intimal thickness growth rate (V). Correlations between echocardiographic indicators, perinatal factors, and clinical treatment were analyzed. On first echo, the PDA-open group showed a significantly lower IT1/D1 than the combined PDA-closure group (P < 0.05). On second echo, the PDA-open group showed a significantly lower IT2 and V than the PDA-closure group as well as a significantly higher D2 (P < 0.05). Smaller gestational age correlated with a larger D2 but smaller IT2 and V (P < 0.05) and a higher level of respiratory support within 72 h post-birth correlated with a larger D2 and smaller IT 2 (P < 0.05). Increasing oxygen demand within 72 h of birth correlated with a larger D1 and D2 (P < 0.05). Echocardiographic assessment of intimal thickness growth in PDA may provide an approach for predicting spontaneous PDA closure, thereby guiding decision-making regarding early intervention.

A predictive model for patent ductus arteriosus seven days postpartum in preterm infants: an ultrasound-based assessment of ductus arteriosus intimal thickness within 24 h after birth

“…The data are shown in Table 2 . Our analyses showed good repeatability and reproducibility for IT measurement by echocardiography ( 12 ).…”

“…We found that neonates without spontaneous DA closure at three days of life tended to have thinner IT and slower IT growth rates. These neonates also had a lower IT/LD within 24 h after birth than those with spontaneous DA closure by three days of life ( 12 ). In this study, the predictive model based on IT demonstrated high internal validation accuracy.…”

“…The ratio of Vdif to Vmax was calculated. LD and IT were measured using an Echopac workstation off-line as described ( 12 ). Figure 1 shows the measurement of IT.…”

“…Recently, our group found that the intimal thickness (IT) of the DA, which can be measured by echocardiography, tended to be thinner and have a slower growth rate in newborns in whom the DA failed to close by three days of life. They also had a smaller ratio of IT to lumen diameter of the DA (LD) within 24 h after birth than that of infants with spontaneous closure ( 12 ). In this study, we describe creating a predictive model that integrates IT measurements—obtained within the first 24 h postpartum—alongside conventional echocardiographic parameters and established clinical risk factors.…”