Article Text

EARLY ECHOCARDIOGRAPHIC CRITERIA FOR PATENT DUCTUS ARTERIOSUS TREATMENT IN VERY PREMATURE INFANTS
  1. R Desandes1,
  2. JM Jellimann1,
  3. M Rouabah1,
  4. F Haddad1,
  5. F Boubred2,
  6. D Semama3,
  7. E Desandes4,
  8. R Vieux1,
  9. JM Hascoet1
  1. 1Neonatology Department, Maternite Regionale Universitaire, Nancy, France
  2. 2Neonatology Department, Assistance Publique Hopitaux, Marseille, France
  3. 3Neonatology Department, CHU, Dijon, France
  4. 4Department of Epidemiology, CAV, Nancy, France

Abstract

Objectives To compare early echocardiographic (ECHO) criteria for patent ductus arteriosus (PDA) and evaluate their value in predicting the response to ibuprofen treatment.

Methods Prospective multicentric cohort study of very low birth weight infants receiving ibuprofen for PDA early treatment indicated when at least 2/4 published ECHO markers were observed: ductal diameter >2 mm, maximum velocity of left–right ductal shunt (LRDS) <2 m/s, mean flow velocity in left pulmonary artery (LPA) >0.4 m/s or end diastolic flow velocity (EDFV) in LPA >0.2 m/s.

Results 252 infants, 28.3 ± 1.2 weeks gestational age were included. 135 had closed ductus on first ECHO, 43 had PDA not meeting treatment criteria and 74 (29%) received ibuprofen. The age at first ECHO was 1.9 ± 0.9 days and 2.1 ± 1.0 at ibuprofen onset of treatment. The best sensitivity and specificity for treatment were LRDS (sensitivity 0.88) and ductal diameter (specificity 1), the best compromise was EDFV (sensitivity 0.86; specificity 0.95). 16 (21.6%) infants failed ibuprofen and required further treatment. LRDS had the best negative predictive value (1) and ductal diameter the best positive predictive value (0.29) for treatment failure. Gestational age, birth weight, antenatal steroids, CRIB score and infection were significantly associated with PDA (p<0.01) but did not influence ECHO criteria.

Conclusion No criterion alone was sufficient for appropriate PDA management. Ductal diameter and LRDS gave the most information but a combination of PDA markers seems required.

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