Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Ductus arteriosus outcome with focus on the initially patent but hemodynamically insignificant ductus in preterm neonates

Abstract

Background/objectives

The hemodynamically insignificant (hisPDA) ductus arteriosus often progresses to hemodynamic significance. In this review, we sought risk factors predictive of progression.

Methods

Early hisPDAs were subdivided into those that closed spontaneously vs. those that progressed to hsPDA.

Results

Sixty percent of early hisPDAs subsequently progressed to hsPDAs. In all but one, the ductus never closed, but rather became progressively more significant over time. The echocardiographic parameters best associated with subsequent progression were an increased transductal diameter (1.81 ± 0.77 vs. 1.21 ± 0.44 mm; p < 0.001) and the presence of diastolic flow reversal. ROC curve analysis showed that the best ductal diameter criterion for predicting the progression to hsPDA was >1.4 (sensitivity = 91; specificity = 81). The combined morbidity score was higher in those infants who progressed to hsPDA as compared with those who did not (p = 0.0038).

Conclusions

Increased ductal diameter and diastolic flow reversal on the first echocardiogram were best correlated with progression of hisPDA to hsPDA.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Sehgal A, Paul E, Menahem S. Functional echocardiography in staging for ductal disease severity: role in predicting outcomes. Eur J Pediatr. 2013;172:179–84.

    Article  Google Scholar 

  2. El-Khuffash A, James AT, Corcoran JD, Dicker P, Franklin O, Elsayed YN, et al. A patent ductus arteriosus severity score predicts chronic lung disease or death before discharge. J Pediatr. 2015;167:1354–61.

    Article  Google Scholar 

  3. Lemmers PM, Benders MJ, D’Ascenzo R, Zethof J, Alderliesten T, Kersbergen KJ, et al. Patent ductus arteriosus and brain volume. Pediatrics. 2016;137:e20153090.

    Article  Google Scholar 

  4. Fink D, El-Khuffash A, McNamara PJ, Nitzan I, Hammerman C. Tale of two patent ductus arteriosus severity scores: similarities and differences. Am J Perinatol. 2018;35:55–58.

    Article  Google Scholar 

  5. El-Mashad AE, El-Mahdy H, El Amrousy D, Elgendy M. Comparative study of the efficacy and safety of paracetamol, ibuprofen, and indomethacin in closure of patent ductus arteriosus in preterm neonates. Eur J Pediatr. 2017;176:233–40.

    Article  CAS  Google Scholar 

  6. Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986;33:179–201.

    Article  CAS  Google Scholar 

  7. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500gm. J Pediatr. 1978;92:529–34.

    Article  CAS  Google Scholar 

  8. International Committee for the Classification of Retinopathy of Prematurity. The international classification of retinopathy of prematurity revisited. Arch Ophthalmol. 2005;123:991–9.

    Article  Google Scholar 

  9. Schena F, Francescato G, Cappelleri A, Picciolli I, Mayer A, Mosca F, et al. Association between hemodynamically significant patent ductus arteriosus and bronchopulmonary dysplasia. J Pediatr. 2015;166:1488–92.

    Article  Google Scholar 

  10. McNamara PJ, Sehgal A. Towards rational management of the patent ductus arteriosus: the need for disease staging. Arch Dis Child Fetal Neonatal Ed. 2007;92:F424–7.

    Article  Google Scholar 

  11. Heymann MA, Rudolph AM. Control of the ductus arteriosus. Physiol Rev. 1975;55:62–78.

    Article  CAS  Google Scholar 

  12. Bin-Nun A, Mimouni FB, Fink D, Sela H, Hammerman C. Elevated nucleated red blood cells at birth predict hemodynamically significant patent ductus arteriosus. J Pediatr. 2016;177:313–5.

    Article  Google Scholar 

  13. Bardanzellu F, Neroni P, Dessì A, Fanos V. Paracetamol in patent ductus arteriosus treatment: efficacious and safe. Biomed Res Int. 2017;2017:1438038.

    Article  Google Scholar 

  14. Benitz WE. Committee on fetus and newborn, american academy of pediatrics. patent ductus arteriosus in preterm infants. Pediatrics. 2016;137:e20153730.

    Article  Google Scholar 

  15. Harling S, Hansen-Pupp I, Baigi A, Pesonen E. Echocardiographic prediction of patent ductus arteriosus in need of therapeutic intervention. Acta Paediatr. 2011;100:231–5.

    Article  CAS  Google Scholar 

  16. Kluckow M, Evans N. Early echocardiographic prediction of symptomatic patent ductus arteriosus in preterm infants undergoing mechanical ventilation. J Pediatr. 1995;127:774–9.

    Article  CAS  Google Scholar 

  17. Sehgal A, Menahem S. Interparametric correlation between echocardiographic markers in preterm infants with patent ductus arteriosus. Pediatr Cardiol. 2013;34:1212–7.

    Article  Google Scholar 

  18. Dix L, Molenschot M, Breur J, de Vries W, Vijlbrief D, Groenendaal F, et al. Cerebral oxygenation and echocardiographic parameters in preterm neonates with a patent ductus arteriosus: an observational study. Arch Dis Child Fetal Neonatal Ed 2016; 2015-309192.

  19. Gonzalez A, Sosenko IR, Chandar J, Hummler H, Claure N, Bancalari E. Influence of infection on patent ductus arteriosus and chronic lung disease in premature infants weighing 1000 grams or less. J Pediatr. 1996;128:470–8.

    Article  CAS  Google Scholar 

  20. van de Bor M, Verloove-Vanhorick SP, Brand R, Ruys JH. Patent ductus arteriosus in a cohort of 1338 preterm infants: a collaborative study. Paediatr Perinat Epidemiol. 1988;2:328–36.

    Article  Google Scholar 

  21. Stoll BJ, Gordon T, Korones SB, Shankaran S, Tyson JE, Bauer CR, et al. Early-onset sepsis in very low birth weight neonates: a report from the national institute of child health and human development neonatal research network. J Pediatr. 1996;129:72–80.

    Article  CAS  Google Scholar 

  22. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD neonatal research network. Pediatrics. 2002;110:285–91.

    Article  Google Scholar 

  23. Dani C, Bertini G, Corsini I, Elia S, Vangi V, Pratesi S, et al. The fate of ductus arteriosus in infants at 23–27 weeks of gestation: from spontaneous closure to ibuprofen resistance. Acta Paediatr. 2008;97:1176–80.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cathy Hammerman.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fink, D., Nitzan, I., Bin-Nun, A. et al. Ductus arteriosus outcome with focus on the initially patent but hemodynamically insignificant ductus in preterm neonates. J Perinatol 38, 1526–1531 (2018). https://doi.org/10.1038/s41372-018-0204-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-018-0204-x

Search

Quick links