Role of sequential functional echocardiography in predicting clinically apparent patent ductus arteriosus in preterm very low birth weight newborns: An observational study

Background The prolonged ductal patency in preterm newborns despite being associated with short- and long-term morbidities has failed to show significant improvement in the long-term outcome with routine ductal treatment. Echocardiography has been shown to have a predictive and diagnostic role in identifying the significant patent ductus arteriosus (PDA) before its clinical detection and providing selective treatment for PDA to avoid unnecessary therapy or delay of necessary therapy. Several echocardiographic ductal markers have been evaluated for their predictive utility with a wide range of sensitivity (26%–100%) and specificity (6%–100%). Ductal diameter, left pulmonary artery (LPA) velocity, and left atrial to aortic width (La/Ao) ratio are the common markers being used routinely for PDA. This research was planned to assess the predictive utility of additional ductal echocardiographic markers in preterm newborns. Methods It was a prospective observational cohort study conducted in the tertiary care neonatal intensive care unit (NICU) at Lady Hardinge Medical College, Delhi. 50 very low birth weight newborns underwent four sequential Echo scans within the first 72 hrs; the first within 12 hours, and the next three scans at completed 24 hrs, 48 hrs, and 72 hrs of age. These newborns were then monitored for clinical signs of PDA up to 2 weeks of life. Results The left atrial volume index (LAVI), left ventricle to aortic width (Lv/Ao ratio), left ventricular output/superior vena cava (LVO/SVC) flow ratio with different cut-off values at different hours of life, shunt pattern and altered blood flow in the anterior cerebral, and superior mesenteric vessels predicted persistence of ductus arteriosus. Conclusion This study provides insights into the predictive utility of additional ductal echo markers apart from the routinely measured ones.