Ductus arteriosus outcome with focus on the initially patent but hemodynamically insignificant ductus in preterm neonates.

BACKGROUND/OBJECTIVES: The hemodynamically insignificant (hisPDA) ductus arteriosus often progresses to hemodynamic significance. In this review, we sought risk factors predictive of progression.

METHODS: Early hisPDAs were subdivided into those that closed spontaneously vs. those that progressed to hsPDA.

RESULTS: Sixty percent of early hisPDAs subsequently progressed to hsPDAs. In all but one, the ductus never closed, but rather became progressively more significant over time. The echocardiographic parameters best associated with subsequent progression were an increased transductal diameter (1.81 ± 0.77 vs. 1.21 ± 0.44 mm; p < 0.001) and the presence of diastolic flow reversal. ROC curve analysis showed that the best ductal diameter criterion for predicting the progression to hsPDA was >1.4 (sensitivity = 91; specificity = 81). The combined morbidity score was higher in those infants who progressed to hsPDA as compared with those who did not (p = 0.0038).

CONCLUSIONS: Increased ductal diameter and diastolic flow reversal on the first echocardiogram were best correlated with progression of hisPDA to hsPDA.