Functional echocardiography in staging for ductal disease severity : role in predicting outcomes

Equipoise persists as to the issue of assigning haemodynamic and clinical significance to a patent ductus arteriosus (PDA). The objective was to ascertain whether echocardiographic scoring of a PDA correlates with outcomes. Unit electronic data base was accessed to identify infants less than 32 weeks' gestation who received ibuprofen for medical closure of the PDA during the period June 2010-June 2012. Echocardiographic score was assigned on the day of therapy and the infants were prospectively followed up to ascertain the occurrence of chronic lung disease (CLD). Logistic regression analysis was used to estimate the association between composite score and occurrence of CLD. Fifty-two infants were identified out of which 27 (52 %) subsequently developed CLD. Echocardiographic parameters were of a significantly higher magnitude in infants who later developed CLD. The median composite score (inter-quartile range) was also significantly higher in this group 26 (24-26) vs. 19 (17-20), p < 0.001). Higher composite scores were associated with increased risk of developing CLD; for every one point increase in composite score, the odds of CLD increased by 78 % (odds ratio (95 % CI): 1.78 (1.35-2.34); p < 0.001).

Infants with a high composite score, assigned according to the staging criteria at the time of treatment, were noted to have a higher incidence of subsequent CLD. Whether disease stratification can be the basis of further RCT's needs prospective evaluation.