How good is clinical examination at detecting a significant patent ductus arteriosus in the preterm neonate? | Archives of Disease in Childhood

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How good is clinical examination at detecting a significant patent ductus arteriosus in the preterm neonate?

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Echocardiograms in the management of PDA in preterm neonates
Jideofor O Menakaya
Published on: 17 February 2003

Published on: 17 February 2003
Echocardiograms in the management of PDA in preterm neonates
- Jideofor O Menakaya, Medical Doctor
- Other Contributors:
  David Roden, David SK Brookfield
Dear Editor
We agree with the conclusion of Urquhart et al. in their review questioning the accuracy of clinical signs in the diagnosis and management of PDA in preterm neonates.[1] A patent duct may have significant haemodynamic consequences - not obvious clinically - that is apparent within the first 24 hours.[2] Early treatment with indomethacin may be advantageous.[3] We recently carried out an audit...
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Dear Editor
We agree with the conclusion of Urquhart et al. in their review questioning the accuracy of clinical signs in the diagnosis and management of PDA in preterm neonates.[1] A patent duct may have significant haemodynamic consequences - not obvious clinically - that is apparent within the first 24 hours.[2] Early treatment with indomethacin may be advantageous.[3] We recently carried out an audit of the use of echocardiography in the management of PDA in our unit over a six month period. There were 57 echocardiographic episodes on 34 babies. The case histories of 26 (76%) babies were reviewed. 22 of the 26 babies (85%) were born before 37 completed weeks. PDA was diagnosed by echocardiogram in 19 babies of which 18 (95%) were preterm. Clinical assessment diagnosed PDA in 11 babies, 10 (91%) were preterm. The mean age at echocardiographic diagnosis was 1.8 [1.5] days and at clinical diagnosis, 4.0[2.3] days. Of the 9 babies that required treatment, 3 babies were managed with fluid restriction alone and 6 babies needed indomethacin. The mean age at indomethacin administration was 6.3[1.2] days. Only 1 baby required surgical ligation. None of the 6 babies received the full course of 6 doses [2 - 5 doses]; 4 babies – duct closed, 1 baby - gastrointestinal complication, 1 baby - persistently large duct on echocardiogram requiring surgical ligation. Babies that needed indomethacin were younger, mean gestational age, 26.8 weeks compared with 31.6 weeks for the whole group and smaller, mean birth weight - 920g compared with 1.73 kg for whole group. From this audit, we conclude that echocardiographic assessments should be carried out as soon as possible after the birth of a preterm baby and management instituted if PDA is diagnosed rather than delay until clinical features appear. Furthermore, once on treatment, echocardiograms may be used to ascertain duct closure and thus tailor the number of doses of indomethacin.
References
(1) Urquhart DS, Nicholl RM. How good is clinical examination at detecting a significant patent ductus arteriosus in the preterm neonate? Arch Dis Child 2003; 88:85-86.
(2) Kluckow M, Evans N. High pulmonary blood flow, the duct and pulmonary haemorrhage. J Paediatr 2000; 137:68-72
(3) Schmidt B, Davis P, Moddemann D, Ohlsson A, Roberts RS, Saigal S, Solimano A, Vincer M, Wright LL. Long Term Effects of Indomethacin Prophylaxis in Extremely-Low-Birth Weight Infants. N Eng J Med 2001; 344:1966-1972.
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Conflict of Interest:
None declared.
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