Reproducibility of the EL-Khuffash PDA severity score and PDA diameter measurements in extremely preterm infants

Smith, Aisling; Mullaly, Rachel; Franklin, Orla; El-Khuffash, Afif

doi:10.1016/j.earlhumdev.2023.105832

Cited by 4 publications

(4 citation statements)

References 8 publications

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“…Indeed, these factors are assumed to be the main determinants for subsequent pulmonary overcirculation and systemic hypoperfusion [ 41 ]. Given that PDA diameter in isolation is known to be poorly predictive, it may be beneficial to combine it with clinical data for a more comprehensive grading [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Patent ductus arteriosus (also non-hemodynamically significant) correlates with poor outcomes in very low birth weight infants. A multicenter cohort study

Chesi,

Rossi,

Ancora

et al. 2024

PLoS ONE

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Objectives To standardize the diagnosis of patent ductus arteriosus (PDA) and report its association with adverse neonatal outcomes in very low birth weight infants (VLBW, birth weight < 1500 g). Study design A multicenter prospective observational study was conducted in Emilia Romagna from March 2018 to October 2019. The association between ultrasound grading of PDA and adverse neonatal outcomes was evaluated after correction for gestational age. A diagnosis of hemodynamically significant PDA (hsPDA) was established when the PDA diameter was ≥ 1.6 mm at the pulmonary end with growing or pulsatile flow pattern, and at least 2 of 3 indexes of pulmonary overcirculation and/or systemic hypoperfusion were present. Results 218 VLBW infants were included. Among infants treated for PDA closure in the first postnatal week, up to 40% did not have hsPDA on ultrasound, but experienced clinical worsening. The risk of death was 15 times higher among neonates with non-hemodynamically significant PDA (non-hsPDA) compared to neonates with no PDA. In contrast, the risk of death was similar between neonates with hsPDA and neonates with no PDA. The occurrence of BPD was 6-fold higher among neonates with hsPDA, with no apparent beneficial role of early treatment for PDA closure. The risk of IVH (grade ≥ 3) and ROP (grade ≥ 3) increased by 8.7-fold and 18-fold, respectively, when both systemic hypoperfusion and pulmonary overcirculation were present in hsPDA. Conclusions The increased risk of mortality in neonates with non-hsPDA underscores the potential inadequacy of criteria for defining hsPDA within the first 3 postnatal days (as they may be adversely affected by other clinically severe factors, i.e. persistent pulmonary hypertension and mechanical ventilation). Parameters such as length, diameter, and morphology may serve as more suitable ultrasound indicators during this period, to be combined with clinical data for individualized management. Additionally, BPD, IVH (grade ≥ 3) and ROP (grade ≥ 3) are associated with hsPDA. The existence of an optimal timeframe for closing PDA to minimize these adverse neonatal outcomes remains uncertain.

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Section: Discussionmentioning

confidence: 99%

Patent ductus arteriosus (also non-hemodynamically significant) correlates with poor outcomes in very low birth weight infants. A multicenter cohort study

Chesi,

Rossi,

Ancora

et al. 2024

PLoS ONE

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“…The application of a PDA score, defines hsPDA and guides management, and has demonstrated notable impacts on neonatal outcomes ( 10 , 36 ). Also, such scores have been found to be reproducible ( 52 ).…”

Section: What Is the Definition Of A Hspda?mentioning

confidence: 94%

Should we “eliminate” PDA shunt in preterm infants? A narrative review

Surak,

Sidhu,

Ting

2024

Front. Pediatr.

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The patent ductus arteriosus frequently poses a significant morbidity in preterm infants, subjecting their immature pulmonary vascular bed to substantial volume overload. This, in turn, results in concurrent hypoperfusion to post-ductal organs, and subsequently alters cerebral blood flow. In addition, treatment has not demonstrated definitive improvements in patient outcomes. Currently, the optimal approach remains a subject of considerable debate with ongoing research controversy regarding the best approach. This article provides a comprehensive review of existing literature.

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“…Recent studies have used more sophisticated PDA assessment tools, but the most consistent echocardiography variable used to define a PDA is diameter which has very poor correlation with shunt volume and hemodynamic significance. [43][44][45][46] In addition to poorly representing current preterm populations and poorly defining the PDA, studies are plagued with excessive crossover. Hundscheid, et al, show that among 32 randomized clinical trials published from 1980 to 2014, greater than 50% of the conservative management groups still received medical therapy for the PDA, and in some studies, as many as 85% of patients randomized to conservative management still received medical therapy.…”

Section: Flawed Studiesmentioning

confidence: 99%

“…67 However, PDA size has very poor correlation with the magnitude of shunting. 46 If TCPC is being considered, TTE also provides information (length of the PDA and the size at the aortic end) to the interventional cardiologist to aid in sizing of the potential device (Figure 3C). Direction and Velocity of Shunt Across the PDA The direction of shunt flow is assessed using pulsed-and continuous-wave Doppler as well as color Doppler and is dependent on the difference in systemic and pulmonary pressures.…”

Section: Pda Physical Characteristics Size and Morphologymentioning

confidence: 99%

Obstacles to the Early Diagnosis and Management of Patent Ductus Arteriosus

Gowda,

Philip,

Weems

2024

RRN

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What we know is little, and what we are ignorant of is immense"; the last words of Laplace still apply to the diagnosis and management of the patent ductus arteriosus (PDA). Despite decades of research, we are searching for the right approach to care for patients with PDA. Nuances of myocardial structural changes and cardiopulmonary interactions with prolonged exposure to excess pulmonary blood flow have played an important role in decision-making. The availability of medical treatments with poor efficacy and, historically, surgical ligation as the only available definitive therapy further widened the gap between observation and definitive closure. As more extremely low birth weight neonates born at earlier gestational ages survive, we are faced with a population whose physiological immaturity and structural alignment of the myocardium predisposes them to myocardial dysfunction and dysregulated vascular tone. Therefore, it may be time to replace historical approaches with a more precise patient-centric therapeutic model. A comprehensive serial echocardiography assessment of the heart function, hemodynamic significance, and clinical context with respect to pulmonary insufficiency and gut perfusion aids the neonatologist in making PDA management decisions. A targeted approach balances risks and benefits of therapy, avoids treatment for infants likely to have early spontaneous closure, and limits prolonged exposure to the pathologic PDA shunt in high-risk infants. There is significant variability in the diagnosis and treatment of the PDA, both within and across centers. This review highlights the clinical obstacles contributing to the variability and illustrates the need for a standardized approach to PDA diagnosis and management.

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Reproducibility of the EL-Khuffash PDA severity score and PDA diameter measurements in extremely preterm infants

Cited by 4 publications

References 8 publications

Patent ductus arteriosus (also non-hemodynamically significant) correlates with poor outcomes in very low birth weight infants. A multicenter cohort study

Patent ductus arteriosus (also non-hemodynamically significant) correlates with poor outcomes in very low birth weight infants. A multicenter cohort study

Should we “eliminate” PDA shunt in preterm infants? A narrative review

Obstacles to the Early Diagnosis and Management of Patent Ductus Arteriosus

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