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Am J Perinatol 2024; 41(12): 1673-1679
DOI: 10.1055/a-2249-1671
Original Article

Early Echocardiographic Predictors of Eventual Need for Patent Ductus Arteriosus Treatment: A Retrospective Study

Jenny Koo
1   Department of Neonatology, Sharp Mary Birch Hospital for Women and Newborns, Sharp Neonatal Research Institute, San Diego, California
,
Nohemi Torres
2   Department of Pediatric Cardiology, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California
,
Anup Katheria
1   Department of Neonatology, Sharp Mary Birch Hospital for Women and Newborns, Sharp Neonatal Research Institute, San Diego, California
› Author Affiliations Funding The parent studies from which data were derived include:
• PREMOD2 (NCT03019367)—1R01HD088646-01
• DOXIE (NCT04413097)—1R03HD105224, TRF01357, NRP Young Investigator Award
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Abstract

Objective Hemodynamically significant patent ductus arteriosus (hsPDA) in preterm neonates is associated with end-organ injury including intraventricular hemorrhage. Early treatment may reduce morbidities but may result in overtreatment. This study aimed to examine the association between commonly obtained echocardiographic markers within the first 12 hours of life and eventual treatment of an hsPDA.

Study Design Patients with <32 weeks' gestational age had blinded echocardiograms done within the first 12 hours of life as part of research protocols. Subsequent treatment of the patent ductus arteriosus (PDA) was determined by the clinical team independent of echocardiogram results. t-tests and chi-square tests were done for continuous data and categorical outcomes. A receiver operating curve was created to optimize cutoff values.

Results Among 199 neonates studied (mean time of echocardiogram 6.7 h after birth), those needing PDA treatment had higher left ventricular output (LVO), right ventricular output (RVO), and superior vena cava (SVC) flow (p-values 0.007, 0.044, and 0.012, respectively). Cutoffs for predicting PDA treatment were LVO > 204 mL/kg/min (63% sensitivity, 66% specificity), RVO > 221 mL/kg/min or SVC flow > 99 mL/kg/min (sensitivities 70 and 43%, specificities 48 and 73%, respectively).

Conclusion Preterm neonates with higher markers of cardiac output in the first 12 hours of birth later required PDA treatment. These data are the first to use standard cardiac output measures in the first 12 hours of life to predict the need for future PDA treatment. Further prospective studies will need to be performed to corroborate these associations between echocardiographic markers and clinical outcomes/morbidities.

Key Points

  • Early diagnosis of hsPDA may prevent severe morbidity and death.

  • There are echocardiographic markers beyond duct size and flow direction that may aid early diagnosis.

  • Cardiac output markers within the first 12 hours of life may predict need for treatment of hsPDA.

Keywords

neonatology - hemodynamics - preterm neonates - cardiac output - pulmonary hemorrhage - intraventricular hemorrhage

Authors' Contributions

The study design and data analysis were undertaken by J.K. and A.K., while data acquisition was a collaborative effort involving J.K. and N.T. The initial draft of the manuscript, including the creation of figures and artwork, was primarily conducted by J.K. Subsequent revisions to the manuscript involved contributions from J.K., A.K., and N.T.




Publication History

Received: 22 August 2023

Accepted: 12 January 2024

Accepted Manuscript online:
18 January 2024

Article published online:
08 February 2024

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