Role of Sequential Functional Echocardiography in Predicting Clinically Apparent Patent Ductus Arteriosus in Preterm Very Low Birth Weight Newborns-An Observational Study
Background-The management of patent ductus arteriosus in preterm neonates continues to be a topic of discussion and controversy. Prolonged ductal patency in preterm neonates has been associated with significant short and long-term morbidities and with increased mortality however, the policy of routine treatment of all during the neonatal period has failed to show significant improvement in the long-term outcome. Echocardiography has emerged as a promising modality to screen newborns at risk of adverse effects of ductal shunting. This helps in identifying PDAs that require treatment to ultimately prevent unnecessary therapy or delay of necessary therapy. There is a multitude of studies that have evaluated a large number of echocardiographic markers for their predictive utility but only a few have included all ductal markers together in a single study. The reported sensitivity (26-100%) and specificity (6-100%) of echocardiographic markers vary over a wide range. Thus, this study was planned to assess the predictive utility of all available ductal markers and their added advantage of having all over few ones in clinically apparent PDA in preterm VLBW newborns.Methods-It was an observational prospective study conducted in tertiary care NICU at Lady Hardinge Medical College, Delhi. Fifty preterms very low birth weight (VLBW) newborns underwent four sequential Echo scans within the first 72 hrs; the first scan within 12 hours, thereafter at 24 hrs,48 hrs, and 72 hrs of age and were monitored clinically for the signs of PDA up to two weeks of life or discharge whichever comes later.Results-The Ductal diameter, pulsatile ductal flow pattern, Left pulmonary artery (LPA) velocity, Left atrial to aortic width (La/Ao) ratio, Left atrial volume index (LAVI), Left ventricle to aortic width (Lv/Ao) ratio, E/A ratio and Left ventricular output/superior vena cava (LVO/SVC) flow ratio predicted clinically apparent PDA during first 72 hours of life.Conclusion- This study provides insights into the predictive utility of other ductal echo markers along with the routinely measured conventional ones during the first 72 hours of life in preterm VLBW newborns.