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J Pediatr. 2015 Dec;167(6):1354-1361.e2. doi: 10.1016/j.jpeds.2015.09.028. Epub 2015 Oct 21.

A Patent Ductus Arteriosus Severity Score Predicts Chronic Lung Disease or Death before Discharge.

Author information

1
Department of Neonatology, The Rotunda Hospital, Dublin, Ireland; Department of Pediatrics, The Royal College of Surgeons in Ireland, Dublin, Ireland. Electronic address: afifelkhuffash@rcsi.ie.
2
Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.
3
Department of Neonatology, The Rotunda Hospital, Dublin, Ireland; Department of Pediatrics, The Royal College of Surgeons in Ireland, Dublin, Ireland.
4
Department of Biostatistics, The Royal College of Surgeons in Ireland, Dublin, Ireland.
5
Department of Pediatric Cardiology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.
6
Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.
7
Department of Pediatrics, University of British Columbia, Vancouver, British Colombia, Canada.
8
Monash Newborn, Monash Children's Hospital, Melbourne, Australia; Department of Pediatrics, Monash University, Melbourne, Australia.
9
Monash Newborn, Monash Children's Hospital, Melbourne, Australia.
10
Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
11
Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Departments of Physiology and Pediatrics, University of Toronto, Toronto, Ontario, Canada.

Abstract

OBJECTIVES:

To test the hypothesis that a patent ductus arteriosus (PDA) severity score (PDAsc) incorporating markers of pulmonary overcirculation and left ventricular (LV) diastolic function can predict chronic lung disease or death before discharge (CLD/death).

STUDY DESIGN:

A multicenter prospective observational study was conducted for infants <29 weeks gestation. An echocardiogram was carried out on day 2 to measure PDA diameter and maximum flow velocity, LV output, diastolic flow in the descending aorta and celiac trunk, and variables of LV function using tissue Doppler imaging. Predictors of CLD/death were identified using logistic regression methods. A PDAsc was created and a receiver operating characteristic curve was constructed to assess its ability to predict CLD/death.

RESULTS:

We studied 141 infants at a mean (SD) gestation and birthweight of 26 (1.4) weeks and 952 (235) g, respectively. Five variables were identified that were independently associated with CLD/death (gestation at birth, PDA diameter, maximum flow velocity, LV output, and LV a' wave). The PDAsc had a range from 0 (low risk) to 13 (high risk). Infants who developed CLD/death had a higher score than those who did not (7.3 [1.8] vs 3.8 [2.0], P < .001). PDAsc had an area under the curve of 0.92 (95% CI 0.86-0.97, P < .001) for the ability to predict CLD/death. A PDAsc cut-off of 5 has sensitivity and specificity of 92% and 87%, and positive and negative predictive values of 92% and 82%, respectively.

CONCLUSIONS:

A PDAsc on day 2 can predict the later occurrence of CLD/death further highlighting the association between PDA significance and morbidity.

PMID:
26474706
DOI:
10.1016/j.jpeds.2015.09.028
[Indexed for MEDLINE]

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