Predictive Model of Early Spontaneous Ductus Arteriosus Closure Based on Neonatologist Performed Echocardiography in Preterm Infants

Frontiers in Pediatrics

article

María Carmen Bravo¹  Rebeca Sánchez¹  Ana Isabel Blanco¹  Itsaso Losantos²  Adelina Pellicer¹ 

[1] Department of Neonatology, La Paz University Hospital;Division of Statistics, La Paz University Hospital

关键词: ductus arteriosus;    echocardiography;    preterm infant;    ibuprofen;    NPE;   

DOI  :  10.3389/fped.2021.644519

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: Patent ductus arteriosus (PDA) treatment remains controversial. Modeling on the predictive capacity of early spontaneous PDA closure would help in decision-making. Aim: To design a predictive model of early spontaneous PDA closure. Methods: As part of a trial to assess efficacy and safety of two ibuprofen treatment schemes for PDA, infants below 29 weeks' gestation were scanned between 18 and 72 h of birth, and serially if indicated. PDA treatment was decided based on echocardiography signs of lung overflow or systemic hypoperfusion and clinical criteria. A PDA score that included the echocardiographic parameters significantly associated with treatment prescription was retrospectively applied. Perinatal variables and screening score were included in a backwards elimination model to predict early spontaneous closure. Results: Among 87 eligible infants (27 weeks' gestation; age at screening 45 h), 21 received ibuprofen at 69 h of life [screening score = 7 (IQR = 5–8.5); score at treatment = 9 (IQR = 8–9)], while 42 infants had conservative management, [screening score = 1 (IQR = 0–4)]. Twenty four infants were excluded (ibuprofen contraindication, declined consent or incomplete echocardiography). Screening score showed an AUC = 0.93 to predict early spontaneous PDA closure, [cut-off value = 4.5 (sensitivity = 0.90, specificity = 0.86)]. The predictive model for early spontaneous PDA closure followed the equation: Log (p/1-p) = −28.41 + 1.23 * gestational age −0.87 * PDA screening score. Conclusions: A predictive model of early spontaneous PDA closure that includes gestational age and the screening PDA score is proposed to help clinicians in the decision- making for PDA treatment. In addition, this model could be used in future intervention trials aimed to prevent PDA related morbidities to improve the eligibility criteria.

【 授权许可】

CC BY