Ratio of arterial blood pressures at borders of window surrounding systolic peak indicates patent ductus arteriosus in preterm infants

Abstract

Objective. Presence of a patent ductus arteriosus (PDA) in neonates is assessed by echocardiography. Echocardiographic assessment has disadvantages, primarily its discontinuous nature. We hypothesize that the continuously measured ratio of arterial blood pressures (ABP) at the borders of a window surrounding the systolic peak ratio discriminates non-PDA from PDA patients. Approach. Preterm infants (gestational age <32 weeks) with and without PDA were included. Patients were divided into controls (n = 8) and PDA patients (n = 22), the latter with a subset of patients with closed PDA after three doses Ibuprofen (n = 10). For each patient, a six-hour ABP segment from 12 AM to 6 AM on the day of echocardiographic assessment patency or closure of the DA was selected. The mean ratio of the ABP values a samples before and p samples after the systolic peak (R ABP) was calculated for each segment. If R ABP < 1, the patient was predicted to have a PDA. The a and p with the least misclassifications were selected (−64 and +104 ms). Main results. R ABP was significantly lower in PDA patients (median 0.95, IQR 0.06) compared to controls (median 1.05, IQR 0.10; p = 0.0024). R ABP correctly predicted 19 out of 22 patients (86.4%) and six out of eight controls (75%). R ABP increased after closure in nine out of 10 patients (median 1.01, IQR 0.04; p = 0. 0182). Significance. R ABP may discriminate preterm PDA patients from non-PDA patients and can be calculated continuously from clinical data measured during standard of care.