Development of a Diagnostic Clinical Score for Hemodynamically Significant Patent Ductus Arteriosus.

Annemarie Kindler,Ursula Range,Antje Heilmann,Barbara Seipolt,Mario Rüdiger,Sigrun Ruth Hofmann

doi:10.3389/fped.2017.00280

Annemarie Kindler, Ursula Range + Show 4 more

Open Access

https://doi.org/10.3389/fped.2017.00280

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Abstract

There is no consensus about the hemodynamic significance and, therefore, the need to treat a persistent ductus arteriosus in preterm newborns. Since the diagnosis of a hemodynamically significant persistent ductus arteriosus (hsPDA) is made by a summary of non-uniform echo-criteria in combination with the clinical deterioration of the preterm neonate, standardized clinical and ultrasound scoring systems are needed. The objective of this study was the development of a clinical score for the detection and follow-up of hsPDA. In this observational cohort study of 154 preterm neonates (mean gestational age 28.1 weeks), clinical signs for the development of hsPDA were recorded in a standardized score and compared to echocardiography. Analyzing the significance of single score parameters compared to the diagnosis by echocardiography, we developed a short clinical score (calculated sensitivity 84% and specificity 80%). In conclusion, this clinical diagnostic PDA score is non-invasive and quickly to implement. The continuous assessment of defined clinical parameters allows for a more precise diagnosis of hemodynamic significance of PDA and, therefore, should help to detect preterm neonates needing PDA-treatment. The score, therefore, allows a more targeted use of echocardiography in these very fragile preterm neonates.

Highlights

The association of hemodynamically significant persistent ductus arteriosus with intraventricular hemorrhage (IVH), pulmonary hemorrhage, bronchopulmonary dysplasia (BPD), and intestinal complications, such as necrotizing enterocolitis (NEC), is an ongoing field of research and discussed controversially [1,2,3,4,5,6]
There is a higher incidence of hemodynamically significant persistent ductus arteriosus (hsPDA) in small for gestational age (GA) infants [33, 34]
In accordance with published data [35], the frequency of hsPDA in our study population is inversely related to GA of preterm infants

Summary

Introduction

The association of hemodynamically significant persistent ductus arteriosus (hsPDA) with intraventricular hemorrhage (IVH), pulmonary hemorrhage, bronchopulmonary dysplasia (BPD), and intestinal complications, such as necrotizing enterocolitis (NEC), is an ongoing field of research and discussed controversially [1,2,3,4,5,6]. Due to the change of fetal to postnatal circulation, with a decrease in pulmonary resistance, the blood flow through the patent arterial duct inverses (from a right-to-left into a left-to-right shunt), leading to a pulmonary overflow and a steal-phenomenon of the systemic circulation. This leads to hemodynamic instability with the following clinical symptoms: respiratory deterioration (RD) (due to increased lung perfusion), increased precordial pulsations, tachycardia, hepatomegaly (HM), accentuated femoral pulses (FP) (due to the ductal steel phenomenon and increased cardiac charge) and oliguria and metabolic acidosis (AC) (due to decreased systemic perfusion)

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