Early echocardiography does not predict subsequent treatment of symptomatic patent ductus arteriosus in extremely preterm infants.

Abstract

To determine whether early echocardiographic ductal parameters identified infants who subsequently received medical or surgical treatment of the patent ductus arteriosus (PDA). Infants <29weeks had PDA size in 2D and colour, flow velocity and patterns obtained on days 1 and 3. Infants were followed up to identify those subsequently receiving treatment for symptomatic PDA by clinicians who were unaware of scan results. Receiver operator characteristics curves and logistic regression were performed. Sixty infants were studied. Mean (SD) gestation and birthweight were 25.8 (1.5) weeks and 817 (190) grams, respectively. Twenty-four (40%) infants received medical treatment, and nine (15%) infants received surgical ligation of PDA at a median age of 12 and 37days, respectively. PDA size on days 1 and 3, change in ductal size between days 1 and 3, flow pattern/velocity did not predict whether infants subsequently received medical or surgical management of PDA. Using logistic regression, gestation (p=0.006) was the only factor that predicted whether infants would subsequently receive medical or surgical treatment for PDA in this cohort. Echocardiographic ductal parameters on day 1 or 3 did not identify infants who received PDA treatment. Gestation was the most powerful predictor for receiving medical or surgical treatment of PDA.