Abstract
Background: Patent ductus arteriosus (PDA) treatment remains controversial. Modeling on the predictive capacity of early spontaneous PDA closure would help in decision-making.Aim: To design a predictive model of early spontaneous PDA closure.Methods: As part of a trial to assess efficacy and safety of two ibuprofen treatment schemes for PDA, infants below 29 weeks' gestation were scanned between 18 and 72 h of birth, and serially if indicated. PDA treatment was decided based on echocardiography signs of lung overflow or systemic hypoperfusion and clinical criteria. A PDA score that included the echocardiographic parameters significantly associated with treatment prescription was retrospectively applied. Perinatal variables and screening score were included in a backwards elimination model to predict early spontaneous closure.Results: Among 87 eligible infants (27 weeks' gestation; age at screening 45 h), 21 received ibuprofen at 69 h of life [screening score = 7 (IQR = 5–8.5); score at treatment = 9 (IQR = 8–9)], while 42 infants had conservative management, [screening score = 1 (IQR = 0–4)]. Twenty four infants were excluded (ibuprofen contraindication, declined consent or incomplete echocardiography). Screening score showed an AUC = 0.93 to predict early spontaneous PDA closure, [cut-off value = 4.5 (sensitivity = 0.90, specificity = 0.86)]. The predictive model for early spontaneous PDA closure followed the equation: Log (p/1-p) = −28.41 + 1.23* gestational age −0.87* PDA screening score.Conclusions: A predictive model of early spontaneous PDA closure that includes gestational age and the screening PDA score is proposed to help clinicians in the decision- making for PDA treatment. In addition, this model could be used in future intervention trials aimed to prevent PDA related morbidities to improve the eligibility criteria.
Highlights
The patent ductus arteriosus (PDA) is associated with several morbidities including intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and death as a result of pulmonary over-circulation and systemic hypoperfusion [1,2,3,4,5,6]
Twenty one infants who were identified as having hemodynamically significant PDA (hsPDA) by neonatologist performed echocardiography (NPE) received ibuprofen treatment (IB-T group) at a median postnatal age of 69 [52–158] h, while 42 infants who did not show echocardiographic signs of hsPDA were not treated and formed the conservative management (CM) group
The backward stepwise regression analysis showed that the best predictive model to estimate the likelihood of early spontaneous PDA closure included the gestational age [OR = 3.44] and the screening PDA score [OR = 0.42], according to the following equation, Log (p/1-p) = −28.41 + 1.23∗ gestational age −0.87∗ PDA score at screening NPE
Summary
The patent ductus arteriosus (PDA) is associated with several morbidities including intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and death as a result of pulmonary over-circulation and systemic hypoperfusion [1,2,3,4,5,6]. The reported spontaneous closure rate reaches 73% at 2 months of postnatal age in extremely low gestational age neonates who survive beyond the neonatal period [11]. None of these approaches have shown a reduction in the prevalence of PDA-related morbidities. Modeling on the predictive capacity of early spontaneous PDA closure would help in decision-making
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