Ductus diameter and left pulmonary artery end-diastolic velocity at 3 days of age predict the future need for surgical closure of patent ductus arteriosus in preterm infants: A post-hoc analysis of a prospective multicenter study

Published:September 02, 2021DOI:https://doi.org/10.1016/j.jjcc.2021.08.007

      Highlights

      • No echo indices for early prediction of ductal surgery have been fully tested.
      • We conducted a post-hoc analysis using a database including 710 preterm infants.
      • This study identified the useful echo indices for early prediction of future ductal surgery.

      Abstract

      Background

      There is inconsistent evidence suggesting the clinical relevance of the early detection of future needs of preterm patent ductus arteriosus (PDA) surgery. We tested the hypothesis that echocardiographic indices at 3 days of age predict the future need for PDA surgery.

      Methods

      We analyzed a database including the clinical and echocardiographic data of 710 preterm infants with gestational ages between 23 and 29 weeks in 34 Japanese neonatal intensive care units, and prospectively collected data over 14 months. The predictive or discriminative ability of each echocardiographic index at 3 days of age for future PDA surgical closure was evaluated using multivariable logistic regression analyses with adjustment for gestational age, sex, and small-for-gestational-age status, according to the areas under the receiver-operating characteristic curves (AUCs) of the models.

      Results

      A total of 688 eligible patients (median gestational age: 26 weeks, body weight at birth: 843 g) were analyzed, of whom 77 (11%) underwent PDA surgery (median age: 21 days) after full consideration of clinical conditions. The AUC of PDA diameter (PDAd) was the largest, followed by that of the left pulmonary artery end-diastolic velocity (LPAedv). Compared with the ratio of left atrial-to-aorta diameter (AUC 0.76), PDAd (AUC 0.84, p < 0.001) and LPAedv (AUC 0.82, p = 0.003) were significantly better predictors of future PDA surgery.

      Conclusion

      Echocardiographic indices at 3 days of age, especially PDAd and LPAedv, may predict the future need for surgical closure of PDA in preterm infants.

      Graphical abstract

      Keywords

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      References

        • Weisz DE
        • Mirea L
        • Rosenberg E
        • Jang M
        • Ly L
        • Church PT
        • et al.
        Association of patent ductus arteriosus ligation with death or neurodevelopmental impairment among extremely preterm infants.
        JAMA Pediatr. 2017; 171: 443-449
        • Matsumura S
        • Masutani S
        • Oshima A
        • Kanai M
        • Namba F
        • Ishiguro A
        • et al.
        Is ibuprofen superior to indomethacin for patent ductus arteriosus in Japanese preterm infants?.
        Pediatr Int. 2020; https://doi.org/10.1111/ped.14566
        • Jain A
        • Shah PS.
        Diagnosis, evaluation, and management of patent ductus arteriosus in preterm neonates.
        JAMA Pediatr. 2015; 169: 863-872
        • El Hajjar M
        • Vaksmann G
        • Rakza T
        • Kongolo G
        • Storme L.
        Severity of the ductal shunt: a comparison of different markers.
        Arch Dis Child Fetal Neonatal Ed. 2005; 90: F419-F422
        • Iyer P
        • Evans N.
        Re-evaluation of the left atrial to aortic root ratio as a marker of patent ductus arteriosus.
        Arch Dis Child Fetal Neonatal Ed. 1994; 70: F112-F117
        • Toyoshima K
        • Masutani S
        • Senzaki H
        • Kawataki M
        • Itani Y.
        Left atrial volume is superior to the ratio of the left atrium to aorta diameter for assessment of the severity of patent ductus arteriosus in extremely low birth weight infants.
        Circ J. 2014; 78: 1701-1709
        • Khositseth A
        • Nuntnarumit P
        • Chongkongkiat P.
        Echocardiographic parameters of patent ductus arteriosus in preterm infants.
        Indian Pediatr. 2011; 48: 773-778
        • Toyoshima K
        • Isayama T
        • Kobayashi T
        • Su C
        • Mikami M
        • Yokoyama T
        • et al.
        What echocardiographic indices are predictive of patent ductus arteriosus surgical closure in early preterm infants? A prospective multicenter cohort study.
        J Cardiol. 2019; 74: 512-518
        • Kluckow M
        • Evans N.
        Early echocardiographic prediction of symptomatic patent ductus arteriosus in preterm infants undergoing mechanical ventilation.
        J Pediatr. 1995; 127: 774-779
        • Evans N
        • Iyer P.
        Longitudinal changes in the diameter of the ductus arteriosus in ventilated preterm infants: correlation with respiratory outcomes.
        Arch Dis Child Fetal Neonatal Ed. 1995; 72: F156-F161
        • Saida K
        • Nakamura T
        • Hiroma T
        • Takigiku K
        • Yasukochi S.
        Preoperative left ventricular internal dimension in end-diastole as earlier identification of early patent ductus arteriosus operation and postoperative intensive care in very low birth weight infants.
        Early Hum Dev. 2013; 89: 821-823
        • Pereira SS
        • Kempley ST
        • Shah DK
        • Morris JK
        • Sinha AK.
        Early echocardiography does not predict subsequent treatment of symptomatic patent ductus arteriosus in extremely preterm infants.
        Acta Paediatr. 2018; 107: 1909-1916
        • Kwinta P
        • Rudzinski A
        • Kruczek P
        • Kordon Z
        • Pietrzyk JJ.
        Can early echocardiographic findings predict patent ductus arteriosus?.
        Neonatology. 2009; 95: 141-148
        • Ramos FG
        • Rosenfeld CR
        • Roy L
        • Koch J
        • Ramaciotti C.
        Echocardiographic predictors of symptomatic patent ductus arteriosus in extremely-low-birth-weight preterm neonates.
        J Perinatol. 2010; 30: 535-539
        • Noori S
        • McCoy M
        • Friedlich P
        • Bright B
        • Gottipati V
        • Seri I
        • et al.
        Failure of ductus arteriosus closure is associated with increased mortality in preterm infants.
        Pediatrics. 2009; 123: e138-e144
        • Bixler GM
        • Powers GC
        • Clark RH
        • Walker MW
        • Tolia VN.
        Changes in the diagnosis and management of patent ductus arteriosus from 2006 to 2015 in United States neonatal intensive care units.
        J Pediatr. 2017; 189: 105-112
        • Roze JC
        • Cambonie G
        • Marchand-Martin L
        • Gournay V
        • Durrmeyer X
        • Durox M
        • et al.
        Association between early screening for patent ductus arteriosus and in-hospital mortality among extremely preterm infants.
        JAMA. 2015; 313: 2441-2448
        • Toyoshima K
        • Kawataki M
        • Itani Y
        • Nakazawa M.
        The tailor-made circulatory management based on the stress-velocity relationship in preterm infants.
        J Formos Med Assoc. 2013; 112: 510-517
        • Japanese Preterm PDA Guideline Group (J-PreP Guideline Group
        Clinical practice guideline for the management of patent ductus arteriosus in preterm or low birth weight infants.
        2009 (Available from) (Japanese, accessed on 13 Aug 2021)
        • Amari S
        • Isayama T
        • Iwami H
        • Sato M
        • Yamamoto M
        • Nozaki M
        • et al.
        Interrater reliability of echocardiographic measurements of still images among neonatologists.
        J Japan Soc Neonatal Health Dev. 2017; 29 ([article in Japanese]): 373-382
        • Lang RM
        • Badano LP
        • Mor-Avi V
        • Afilalo J
        • Armstrong A
        • Ernande L
        • et al.
        Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.
        J Am Soc Echocardiogr. 2015; 28 (e14): 1-39
        • Desandes R
        • Jellimann JM
        • Rouabah M
        • Haddad F
        • Desandes E
        • Boubred F
        • et al.
        Echocardiography as a guide for patent ductus arteriosus ibuprofen treatment and efficacy prediction.
        Pediatr Crit Care Med. 2012; 13: 324-327
        • Lang RM
        • Bierig M
        • Devereux RB
        • Flachskampf FA
        • Foster E
        • Pellikka PA
        • et al.
        Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.
        J Am Soc Echocardiogr. 2005; 18: 1440-1463
        • Wang Y
        • Gutman JM
        • Heilbron D
        • Wahr D
        • Schiller NB.
        Atrial volume in a normal adult population by two-dimensional echocardiography.
        Chest. 1984; 86: 595-601
        • Badano LP
        • Pezzutto N
        • Marinigh R
        • Cinello M
        • Nucifora G
        • Pavoni D
        • et al.
        How many patients would be misclassified using M-mode and two-dimensional estimates of left atrial size instead of left atrial volume? A three-dimensional echocardiographic study.
        J Cardiovasc Med (Hagerstown). 2008; 9: 476-484
        • Tape TG.
        Interpreting Diagnostic Tests. 5 Jun 2018; (. Available from http://gim.unmc.edu/dxtests/ (Accessed on 5 Jun 2018))
        • DeLong ER
        • DeLong DM
        • Clarke-Pearson DL.
        Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach.
        Biometrics. 1988; 44: 837-845
        • Yokoyama U
        • Minamisawa S
        • Ishikawa Y.
        Regulation of vascular tone and remodeling of the ductus arteriosus.
        J Smooth Muscle Res. 2010; 46: 77-87
        • Yokoyama U.
        Prostaglandin E-mediated molecular mechanisms driving remodeling of the ductus arteriosus.
        Pediatr Int. 2015; 57: 820-827
        • Koch J
        • Hensley G
        • Roy L
        • Brown S
        • Ramaciotti C
        • Rosenfeld CR.
        Prevalence of spontaneous closure of the ductus arteriosus in neonates at a birth weight of 1000 grams or less.
        Pediatrics. 2006; 117: 1113-1121
        • de Waal K
        • Phad N
        • Stubbs M
        • Chen Y
        • Kluckow M.
        A randomized placebo-controlled pilot trial of early targeted nonsteroidal anti-inflammatory drugs in preterm infants with a patent ductus arteriosus.
        J Pediatr. 2021; 228 (e2): 82-86
        • Hundscheid T
        • Onland W
        • van Overmeire B
        • Dijk P
        • van Kaam A
        • Dijkman KP
        • et al.
        Early treatment versus expectative management of patent ductus arteriosus in preterm infants: a multicentre, randomised, non-inferiority trial in Europe (BeNeDuctus trial).
        BMC Pediatr. 2018; 18: 262
      1. Does selective early treatment of patent ductus arteriosus in extreme preterm infants reduce the complications and improve their long-term outcome? ISRCTN84264977. Available from: https://www.isrctn.com/ISRCTN84264977. (Accessed on 24 Jan 2021).

        • Isayama T
        • Kusuda S
        • Reichman B
        • Lee SK
        • Lehtonen L
        • Norman M
        • et al.
        Neonatal intensive care unit-level patent ductus arteriosus treatment rates and outcomes in infants born extremely preterm.
        J Pediatr. 2020; 220 (e5): 34-39