Objectives To determine whether a composite PDA score (Manitoba score), determined at 48–72 hours of age can predict a hemodynamically significant PDA (HSPDA) requiring closure in Infants <31 weeks.
Study Design Infants <31 weeks GA, admitted August 2010 to September 2011, to NICU Winnipeg, Canada, following parental consent, had a blinded echocardiogram and a novel PDA score determined at 48–72 hours postnatally. The PDA score is a numerical score (maximum 28) incorporating echocardiographic parameters reflective of both volume and pressure overload (max score 15), and clinical, radiological and laboratory features of both pulmonary over-circulation and systemic hypo-perfusion (max score 13). PDA diameter >1.5mm with left to right non-restrictive shunt by echo was considered for this study the reference standard for HSPDA requiring treatment. All components of the score were correlated with this reference standard.
Results 70 of 132 eligible neonates were studied. HSPDA was present in 24 (34%) infants, a non significant PDA in 32 (46%) and no PDA in 14 (20%). Infants with HSPDA were of lower birth weight and less mature than those without (non-HSPDA/no PDA) (905±46 vs. 1218±43 grams; p<0.001, 28.6 ±0.3 vs. 26.8± 0.3 weeks). Both the clinical and echo component correlated strongly with each other and with overall score (p<0.001, Kendall’s tau test. The PDA score and components significantly predicted HSPDA.
Conclusion The Manitoba PDA score performed at 48–72 hours of age predicts HSPDA who eventually received treatment. Use of PDA score may reduce the number of infants who are treated with non significant PDA.