Echocardiography as a guide for patent ductus arteriosus ibuprofen treatment and efficacy prediction

Pediatric Critical Care Medicine, 05/15/2012

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.

Methods

  • 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.

Results

  • 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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