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Updated: May 31, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Echocardiography as a guide for patent ductus arteriosus ibuprofen treatment and efficacy prediction
Roxane Desandes1, Jean-Marc Jellimann, Mahmoud Rouabah
1Department of Neonatology, Maternite Regionale Universitaire, Nancy, France.
Insights
Echocardiography can help manage patent ductus arteriosus (PDA) in preterm infants treated with ibuprofen. Combining ductal diameter and shunt velocity criteria improves prediction of treatment response.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Medical Imaging
Background:
- Patent ductus arteriosus (PDA) is common in preterm infants.
- Ibuprofen is a common treatment for PDA.
- Predicting ibuprofen response is crucial for effective management.
Purpose of the Study:
- To evaluate echocardiography criteria for predicting ibuprofen treatment response in preterm infants with PDA.
- To determine which echocardiographic parameters are most effective in predicting treatment success.
Main Methods:
- Prospective cohort study in three academic NICUs.
- Included 252 preterm infants (27-31 weeks gestation).
- Assessed four echocardiography criteria for ibuprofen indication and treatment response.
Main Results:
- 74 infants received ibuprofen; 16 failed treatment, 9 required surgery.
- Ductal diameter >2 mm had the best positive predictive value.
- Left-right ductal shunt maximum velocity <2 m/sec had the best negative predictive value.
Conclusions:
- Echocardiography is a valuable tool for managing PDA in preterm infants.
- Combining ductal diameter and shunt velocity criteria enhances prediction of ibuprofen response.
- Optimized echocardiographic assessment can guide PDA treatment decisions.
Objective:
To evaluate echocardiography criteria in predicting the response to ibuprofen treatment.
Design:
A prospective cohort study of preterm infants untreated or treated with ibuprofen for patent ductus arteriosus.
Setting:
Three academic neonatal intensive care units.
Patients:
Two hundred fifty-two preterm infants of 27-31 wks gestation.
Interventions:
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 >2 mm, left-right ductal shunt maximum velocity <2 m/sec, mean flow velocity in left pulmonary artery >0.4 m/sec, and end-diastolic flow velocity in left pulmonary artery >0.2 m/sec.
Measurements And Main Results:
Of the infants analyzed, 135 had a closed ductus at an average age of 1.9 ± 0.9 days, 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.
Conclusions:
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.
