Elsevier

The Journal of Pediatrics

Volume 127, Issue 5, November 1995, Pages 774-779
The Journal of Pediatrics

Early echocardiographic prediction of symptomatic patent ductus arteriosus in preterm infants undergoing mechanical ventilation,☆☆,

https://doi.org/10.1016/S0022-3476(95)70172-9Get rights and content

Abstract

Objective: To identify early echocardiographic markers allowing prediction of subsequent symptomatic patent ductus arteriosus (PDA). Methods: One hundred sixteen preterm infants (<1500 gm) requiring mechanical ventilation underwent echocardiography at a mean postnatal age of 19 hours (range, 7 to 31 hours). Four potential markers were studied: the left atrial to aortic root ratio, pulsed Doppler measurement of left ventricular output, the minimum diameter of the color Doppler signal within the course of the duct (ductal diameter), and the direction of postductal aortic diastolic flow. Subsequent ductal closure or significant patency (if suspected clinically) was confirmed echocardiographically. Results: A significant PDA developed in 42 infants (36%). Ductal diameter was the most accurate echocardiographic marker in predicting subsequent significant PDA. With a ductal diameter of 1.5 mm or greater there were 34 true-positive, 11 false-positive, 63 true-negative, and 8 false-negative results, giving a positive likelihood ratio of 5.5 and a negative likelihood ratio of 0.22 for prediction of development of a PDA requiring treatment. The sensitivity was 81% and the specificity was 85%. Only one infant older than 28 weeks of gestational age had a significant PDA, and limiting the analysis to infants younger than 29 weeks of gestation further improved the predictive accuracy of ductal diameter. The positive likelihood ratio was 8.1 and the negative likelihood ratio was 0.19, with a sensitivity of 83% and a specificity of 90%. Conclusion: Color Doppler measurement of the internal ductal diameter allows early prediction of significant PDA in preterm infants. (J PEDIATR 1995;127:774-9)

Section snippets

METHODS

One hundred sixteen premature infants weighing less than 1500 gm and with respiratory symptoms likely to require ventilation for more than 24 hours underwent echocardiographic studies between 7 and 31 hours of life (mean, 19 hours). Two study enrollment periods were included in the analysis. The first (48 babies) had echocardiograms obtained on a daily basis for the first 7 days; measurements were done early, but occasionally the investigator knew the outcome with respect to a significant PDA.

Population

During the two study periods (February 1992 through March 1993 and June 1993 through July 1994) a total of 145 infants admitted to our neonatal intensive care unit met the entry criteria for the study. Of these, 21 (14%) were not studied because neither of the investigators was available to perform echocardiography; 124 infants (86%) were entered into the study. Of these, eight were excluded from the analysis-three because they were scanned after 48 hours of age, one because of the presence of

DISCUSSION

This study has demonstrated that early prediction of a significant PDA is possible using the measurement of ductal diameter on color flow Doppler mapping. It seems that the rate of early ductal constriction is closely related to the likelihood of later development of significant PDA. Eleven infants had large ducts on the first day that subsequently closed spontaneously (false-positive group). This group was more mature and had a higher average birth weight. Their greater maturity may enable

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    From the Department of Perinatal Medicine, King George Vth Hospital, Royal Prince Alfred Hospitals, Camperdown, Australia

    ☆☆

    Reprint requests: Nick Evans, DM, Department of Perinatal Medicine, King George Vth Hospital, Missenden Rd., Camperdown, New South Wales 2050, Australia.

    0022-3476/95/$5.00 + 0 9/23/67469

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