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Early Echocardiography Does Not Predict Treatment of Patent Ductus Arteriosus in Extremely Premature Infants

Presented at the Neonatal Society 2015 Summer Meeting (programme).

Pereira SS, Kempley ST, Shah DK, Sinha AK

Neonatal Unit, The Royal London Hospital, London E1 1BB
Blizard Institute, Barts and the London School of Medicine and Dentistry, QMUL, London E1 2AT

Background: The persistence of Patent Ductus Arteriosus (PDA) in extremely preterm infants is a frequently encountered problem associated with increased morbidity and mortality. Identifying infants who are likely to have a persistent PDA may help to target treatment and reduce associated complications with PDA (1).

Methods: This study analysed prospectively collected data from a clinical and echocardiographic trial performed in the Neonatal Unit, Royal London Hospital from February 2013 to July 2014. Infants less than 29 weeks gestation were recruited. Echocardiography was performed on day 1 and 3 of postnatal life. PDA size in B&W and colour, velocity of flow in PDA and flow pattern (2) were obtained. Infants were followed up to monitor those who required medical and surgical management of their PDA. Non-parametric tests were performed for analysis of data using SPSS v22. Regional ethics committee approval (Reference 12/LO/1553) and written parental consent were obtained prior to the start of the study.

Results: 33 infants have been studied. The median (IQR) gestation was 26(25-27.1) weeks and birth weight 800 (680- 945) grams. Of the 33 infants, 13(39%) required medical treatment for PDA and 6(18%) infants received surgical ligation of the PDA. The median (IQR) PDA size in colour was 1.5(1.2-1.8) mm on day 1 and 1.1(0-1.6) mm in colour on day 3. All infants who had surgical PDA ligation were less than 26 weeks gestation and were ventilator dependant. PDA size measurements (B&W and colour) on day 1 and 3, change in ductal size between days 1 and 3, flow pattern/velocity, or PDA measuring > 1.5 mm did not predict if infants would subsequently receive medical or surgical management of the PDA in this cohort. Using stepwise logistic regression, we found that gestation was the only factor that predicted if the infant would subsequently receive medical (p=0.01) or surgical (p=0.025) treatment for PDA.

Conclusion: It was not possible to predict which infants would receive treatment for PDA based on ductal size, change in ductal size, flow velocity or flow pattern in the first three days of life. Gestational age was the only predictor for receiving medical or surgical treatment of the ductus arteriosus.

Corresponding author:

1. Early echocardiographic prediction of symptomatic patent ductus arteriosus in preterm infants undergoing mechanical ventilation. Martin Kluckow and Nick Evans, J Pediatr1995;I 27:774-9
2. Su et al. Echocardiographic flow pattern of patent ductus arteriosus: a guide to indomethacin treatment in premature infants. Arch Dis Child Fetal Neonatal Ed 1999; 81:F197-F200

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