Echocardiography as a guide for patent ductus arteriosus ibuprofen treatment and efficacy prediction
Pediatric Critical Care, 05/15/2012
Desandes 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.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.
- 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.