Echocardiography as a guide for patent ductus arteriosus ibuprofen treatment and efficacy prediction
Pediatric Critical Care Medicine, 05/15/2012Desandes R et al.
Echocardiography may be a useful tool to help patent ductus arteriosus management. A combined use of ductal diameter and left–right ductal shunt maximum velocity criteria allows a more accurate prediction of the response of infants with patent ductus arteriosus to ibuprofen treatment.
Two hundred fifty–two preterm infants of 27–31wks gestation.
Ibuprofen treatment within the first 5 days of life was indicated when at least two out of four conventional echocardiography criteria were observed: ductal diameter >2mm, left–right ductal shunt maximum velocity <2m/sec, mean flow velocity in left pulmonary artery >0.4m/sec, and end–diastolic flow velocity in left pulmonary artery >0.2m/sec.
Of the infants analyzed, 135 had a closed ductus at an average age of 1.9±0.9days, and 43 had an open ductus but <2 predefined criteria.
Seventy–four infants (29%) received ibuprofen on day 2.2±1.1.
Sixteen infants failed ibuprofen and nine had to undergo surgical ligation.
The left–right ductal shunt maximum velocity criterion had the best negative predictive value for treatment response, while the ductal diameter criterion had the best positive predictive value.
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