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Updated: Nov 7, 2025
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Protective factors against preterm infants to develop significant patent ductus arteriosus
Hsiao-Wen Huang1, Chih Lin1, Kai-Hsiang Hsu2
1Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan.
Insights
A new scoring system predicts spontaneous closure of patent ductus arteriosus (PDA) in preterm infants within the first week of life. This tool aids clinicians in managing PDA by assessing gestational age, oxygen index, and intubation needs.
Area of Science:
- Neonatology
- Pediatric Cardiology
- Medical Informatics
Background:
- Patent ductus arteriosus (PDA) closure is crucial for preterm infants.
- Predicting spontaneous PDA closure aids in clinical management.
- Very low birthweight (VLBW) infants require careful monitoring for PDA.
Purpose of the Study:
- To assess daily PDA status in VLBW preterm infants during their first week of life.
- To develop a predictive scoring system for spontaneous PDA closure.
- To identify factors influencing PDA closure in preterm neonates.
Main Methods:
- Daily echocardiographic screening for PDA in VLBW infants.
- Utilized Oxygen Index (OI) to represent respiratory status.
- Developed a scoring system based on gestational age (GA), OI, and endotracheal intubation needs.
Main Results:
- Spontaneous PDA closure by 1 week occurred in 80% (GA ≥30 wks), 70% (28-29 wks), and 34% (≤27 wks).
- Factors associated with closure included higher GA, lower OI (<2.5), and less need for intubation.
- A scoring system (GA, OI, intubation) achieved 77% sensitivity and 72% specificity for predicting closure.
Conclusions:
- A novel scoring system effectively predicts spontaneous PDA closure in preterm infants.
- The score integrates GA, OI, and intubation status for clinical utility.
- This tool can assist clinicians in optimizing PDA management strategies for VLBW neonates.
Background:
Identifying preterm infants with a higher likelihood of spontaneous patent ductus arteriosus (PDA) closure would be desirable. This study aimed to examine daily PDA status during the first week of life for very low birthweight (VLBW, <1500 g) preterm infants and to develop a scoring system to predict spontaneous PDA closure.
Methods:
We enrolled VLBW infants admitted between January 2016 and January 2017 and performed daily echocardiographic screening for PDA existence. Oxygen index (OI, mean airway pressure × fraction of inspired oxygen/partial pressure of arterial oxygen) was applied to represent the respiratory condition.
Results:
A total of 215 VLBW infants were enrolled, and the accumulative incidence of spontaneous PDA closure by age 1 week was 80%, 70%, and 34% for infants born of gestational age (GA) ≥30, 28-29, and ≤27 weeks, respectively. Of these 215 infants, 184 infants entered the second phase to establish the scoring system. Infants with spontaneous PDA closure were more mature (GA 29.2 ± 2.3 vs. 26.9 ± 2.3 weeks, p < 0.001), had lower OI (2.8 ± 2.2 vs. 5.6 ± 5.3, p < 0.001) and were less likely to need endotracheal intubation (23% vs. 68%, p < 0.001). Using the receiver operating characteristics curve, OI <2.5 was determined favoring higher PDA closure incidence. The score was calculated based on the odds ratio generated in multiple regression: 4, 3 and 1 points for GA ≥30, 28-29 and ≤27 weeks, 2 and 1 points for OI <2.5 and ≥2.5, and 3 and 1 points for without and with endotracheal intubation. Using score ≥6 to predict PDA closure, the sensitivity and specificity were 0.77 and 0.72.
Conclusion:
A score made up of GA, OI and need for intubation was proposed to predict spontaneous PDA closure by age 1 week, which could be helpful to clinicians in the management of PDA in preterm infants.
