Abstract
Background Patent ductus arteriosus (PDA) is a common problem in preterm very low birth weight neonates. While PDA is known to have negative impact on neonates, treatment of PDA has its own complications, and not all PDAs need treatment. Therefore, echocardiographic parameters which might help in the management of PDA will be useful for clinicians.
Objectives To study diagnostic accuracy of echocardiographic parameters on the third day of life in predicting spontaneous closure of ductus arteriosus in preterm very low birth weight neonates
Methods A hospital-based cross-sectional descriptive study was performed in Neonatal Intensive Care Unit (NICU) of 550-bedded Children Hospital, Mandalay, over one year period (from January, 2019 to December, 2019). A total of 63 preterm neonates with birth weight ≤1.5 kg and/or gestational age ≤32 weeks, who had patent ductus arteriosus were studied. Gestational age assessment was made by using the New Ballard Scoring System. On the third day of life, echocardiographic measurement of ductal diameter and LA/Ao ratio was done by the neonatologist. The measurements made by the neonatologist were reviewed and corrected if necessary by the pediatric cardiologist. Decision to treat PDA was made by the neonatologist based on the NICU protocol. On the tenth day of life, patent ductus arteriosus was re-assessed echocardiographically.
Results On the third day of life, most of the PDAs (67.6%) had ductal diameter <1.6 mm. The number of PDAs with LA/Ao ratio <1.5 and those with LA/Ao ratio ≥1.5 were almost equal (31 vs 32). On the tenth day of life, 47.6% of neonates with PDA had spontaneous ductal closure, 38.1% had persistent PDA and 14.3% had ductal closure after treatment. Spontaneous ductal closure was more commonly observed in PDAs with ductal diameter <1.6 mm than those with ductal diameter ≥1.6 mm (61.3% vs 15.7%). There was a statistically significant association between ductal diameter and spontaneous ductal closure (p value = 0.001). The diagnostic accuracy of ductal diameter in predicting spontaneous ductal closure is 68%. In the neonates with LA/Ao ratio <1.5, 64.5% had spontaneous ductal closure on the tenth day of life. In those with LA/Ao ratio ≥1.5, 31.2% had spontaneous ductal closure on the tenth day of life. There was a statistically significant association between LA/Ao ratio and spontaneous ductal closure on the tenth day of life (p value = 0.008). The diagnostic accuracy of LA/Ao ratio in predicting spontaneous ductal closure is 66%. In PDAs with ductal diameter ≥1.6 mm and LA/Ao ratio ≥1.5, only 11% had spontaneous ductal closure. The diagnostic accuracy of ductal diameter and LA/Ao ratio in combination is 70%.
Conclusions In this study, ductal diameter and LA/Ao ratio on the third day of life were found to have acceptable diagnostic accuracy in predicting spontaneous ductal closure on the tenth day of life.When ductal diameter and LA/Ao ratio were used in combination, diagnostic accuracy was found to improve marginally.
