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Can a clinical decision rule help ductus arteriosus management in preterm neonates?
Author(s) -
Cambonie Gilles,
Dupuy AnneMarie,
Combes Clémentine,
Vincenti Marie,
Mesnage Renaud,
Cristol JeanPaul
Publication year - 2012
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/j.1651-2227.2011.02469.x
Subject(s) - medicine , ductus arteriosus , gestational age , respiratory distress , birth weight , univariate analysis , diastole , pediatrics , cardiology , natriuretic peptide , pulmonary artery , anesthesia , pregnancy , heart failure , blood pressure , multivariate analysis , genetics , biology
Aim: Patent ductus arteriosus (DA) occurs frequently in premature neonates with respiratory distress syndrome. We assessed a combination of clinical, biological and echocardiographic parameters to derive a decision rule for selecting candidates for treatment based on the criteria in use in our unit. Methods: Hundred and forty neonates with a mean (SD) gestational age of 28 (2.3) weeks and a mean birth weight of 1159 (386) g, all requiring invasive ventilation with FiO 2 > 0.3 or catecholamines for severe hypotension, were assessed prospectively using echocardiography in conjunction with N‐terminal pro‐B‐type natriuretic peptide (NTpBNP) levels within 24–72 h of birth. Independent predictors of DA treatment were identified with univariate analysis and combined in a clinical decision rule. Results: Early treatment of significant DA was adopted for 26 (18.6%) neonates. A clinical decision rule suggesting treatment in patients with NTpBNP > 8500 pg/mL, ductal diameter >1.5 mm and, for infants with a birth weight >830 g, left pulmonary artery end‐diastolic velocity >0.20 m/sec showed 88% sensitivity and 94% specificity. Conclusions: A decision rule using realistic and/or commonly used parameters for significant patent ductus arteriosus assessment could be derived. External validation of this rule is needed before any application.