SIMPLE: A Novel Scoring System for Predicting Hemodynamically Significant Patent Ductus Arteriosus Without Echocardiographic Evaluation in Extremely Low Birth Weight Infants.

Ilker Gonen,Beril Yasa,Merih Cetinkaya,Aslan Babayigit,Seda Yilmaz Semerci,Seyma Memur,Helen Bornaun

doi:10.3389/fped.2021.649515

Abstract

Aim: To develop a novel clinical scoring system for predicting hemodynamically significant patent ductus arteriosus (hsPDA) in extremely low birth weight (ELBW) infants.Methods: A prospective observational study was conducted among ELBW infants born in the study center during a 6-month period. Fourteen items were selected on a literature review basis and weighed by severity on an arbitrary 1–4 scale, the sum of which represented the Scoring preterm Infants for PDA cLinically without Echocardiographic evaluation (SIMPLE) score. The SIMPLE scores were compared at several time points during the first 3 days of life between two groups of patients: those with an hsPDA at echocardiography and those without.Results: A total of 48 ELBW infants were enrolled, of which 30 infants developed hsPDA. The SIMPLE scores of the infants with hsPDA were significantly greater than those of the infants who did not develop hsPDA. Cut-off SIMPLE scores that were significantly associated with detection of symptomatic hsPDA at each evaluation time point were identified.Conclusions: SIMPLE is the first scoring system that depends on the risk factors and clinical findings of ELBW infants for early prediction of hsPDA. It is simple, objective and easy to perform, and it does not require any additional tests and/or echocardiographic evaluation. We suggest that SIMPLE can be used as a screening tool for determining the need for echocardiographic evaluation in ELBW infants in order to minimize the number of unnecessary pediatric cardiology consultations.

Highlights

Ductus arteriosus (DA) is an anatomical channel that exists between the pulmonary artery and the aorta
patent ductus arteriosus (PDA) is associated with longterm morbidities, such as bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), focal intestinal perforation, intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), neurodevelopmental retardation, and death [3, 5, 6]
There were no significant differences between infants with and without hemodynamically significant PDA (hsPDA) in terms of duration of mechanical ventilation (MV), oxygen treatment, and hospitalization (Table 2)

Summary

Introduction

Ductus arteriosus (DA) is an anatomical channel that exists between the pulmonary artery and the aorta. DA is maintained in open conformation throughout fetal life while its persistency after birth is called patent ductus arteriosus (PDA). DA closes physiologically within 72 h of life in term infants, it often remains open due to several factors including immaturity, higher prostaglandin levels, respiratory distress, fluid overload, sepsis, and hypoxia in preterm infants [1,2,3]. Spontaneous PDA closure rates for premature infants

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