Early echocardiographic prediction of ductal closure in neonates ≤ 30 weeks gestation.

ABSTRACT

OBJECTIVE: To determine the accuracy of the patent ductus arteriosusleft pulmonary artery ratio (PDALPA) on echocardiogram (ECHO) at 3-day postnatal in predicting spontaneous PDA closure in neonates ≤ 30 weeks gestational age (GA). STUDY DESIGN: ECHOs were performed at 72 h to characterize PDA size as closed-to-small (PDALPA <0.5) or moderate-to-large (PDALPA ≥ 0.5) and at 10 days to determine spontaneous closure (defined as closed-to-small in the absence of medical and/or surgical treatment). Caretakers were blinded to results; treatment was based on standard care. Neonates were prospectively enrolled and stratified <27 weeks (n=31) and 27 to 30 weeks (n=65). RESULT: Neonates <27 weeks with closed-to-small PDAs had 60% spontaneous closure vs 9% when moderate-to-large (positive predictive value (PPV) 60%, negative predictive value (NPV) 91%). Neonates 27 to 30 weeks had 95% spontaneous closure vs 27%, respectively (PPV 95%, NPV 73%). Inter-observer variability for the initial ECHO was 0.84. CONCLUSION: PDA size defined by PDALPA at 3 days postnatal in combination with GA predicts spontaneous PDA closure.