Echocardiographic prediction of patent ductus arteriosus in need of therapeutic intervention

• Published in: Acta Paediatrica Vol. 100; no. 2; pp. 231 - 235
• Main Authors: Harling, S, Hansen-Pupp, I, Baigi, A, Pesonen, E
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-02-2011; Blackwell; Wiley Subscription Services, Inc
• Subjects: Biological and medical sciences; Cardiovascular system; Clinical Medicine; Colour Doppler echocardiography; Diseases of mother, fetus and pregnancy; Ductus Arteriosus, Patent - diagnostic imaging; Ductus Arteriosus, Patent - therapy; General aspects; Gynecology. Andrology. Obstetrics; Humans; Infant, Newborn; Infant, Premature, Diseases - diagnostic imaging; Investigative techniques, diagnostic techniques (general aspects); Klinisk medicin; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Patent ductus arteriosus; Pediatrics; Pediatrik; Prediction; Predictive Value of Tests; Pregnancy. Fetus. Placenta; Prospective Studies; Ultrasonic investigative techniques; Ultrasonography; Very low birthweight infant; Sonography; Human; Doppler ultrasound study; Premature; Pediatrics; Echocardiography; Pregnancy disorders; Patent ductus arteriosus; Colour Doppler echocardiography; Color; Prediction; Persistence of ductus arteriosus; Infant; Very low birthweight infant; Very low birthweight; Newborn diseases; Need; Treatment; Prematurity; Predictive factor
• ISSN: 0803-5253; 1651-2227; 1651-2227
• DOI: 10.1111/j.1651-2227.2010.02027.x

Aim:  To evaluate the efficacy of various echocardiographic markers in predicting a patent ductus arteriosus (PDA) in need of treatment.
Methods:  Forty‐five preterm infants with a mean (SD) gestational age of 27.7 (1.9) weeks underwent echocardiography at a postnatal age of 24 ± 6 and 72 ± 6 h. Four echocardiographic markers were studied: ductus diameter, ductal flow Doppler curves, the left atrial to aortic root (LA/Ao) ratio and Doppler pixels representing ductal shunting.
Results:  Twenty‐eight infants had a PDA with a detectable left‐to‐right shunt. Of these, 12 (43%) were treated for a shunt through the PDA. Ductal diameter was the most accurate echocardiographic marker when it came to predicting a significant shunt, with a sensitivity of 89%, a specificity of 70%, a positive likelihood ratio of 2.97 and a negative likelihood ratio of 0.16 at the age of 72 h. The efficacy of the method at 72 h of age was 84%. The corresponding efficacy of the pulsatile Doppler curve was 72%, percentage of green colour pixels 63% and the LA/Ao ratio 53%.
Conclusion:  Ductus diameter appears to be the most important variable in determining the need for therapeutic intervention for PDA in preterm infants.