Umapathi Krishna Kishore, Muller Brieann, Sosnowski Cyndi, Thavamani Aravind, Murphy Joshua, Awad Sawsan, Bokowski John W
Department of Pediatrics, Division of Pediatric Cardiology, Rush University Medical Center, Chicago, IL 60612, USA.
Department of Pediatrics, Division of Pediatric Gastroenterology, UH Rainbow Babies Children's Hospital, Case Western Reserve University, Cleveland, OH 44106, USA.
J Cardiovasc Dev Dis. 2022 Apr 12;9(4):114. doi: 10.3390/jcdd9040114.
Background: Patent Ductus Arteriosus (PDA) in premature neonates has been associated with comorbidities including chronic lung disease (CLD), and death. However, the treatment of PDA remains controversial. There have been several echocardiographic variables previously used to determine the hemodynamic significance of PDA but their utility in early prediction of clinical outcomes is not well studied. Objective: The objective of our study was to evaluate the use of a severity scoring system incorporating markers of systemic under perfusion, pulmonary over perfusion and left ventricular (LV) function in predicting clinical outcomes in premature neonates. Methods: It is a single center prospective observational study involving newborns < 32 weeks’ gestation. An echocardiogram was done within seven days of life to measure variables previously known to predict severity of shunting in PDA including pulmonary perfusion index (PPI). Predictors of CLD/death were identified using multivariate logistic regression. A severity score was derived and its ability to predict clinical outcomes was tested using a receiver operating characteristic curve. Results: We studied 98 infants with a mean (SD) gestation of 28.9 ± 1.91 weeks and birth weight of 1228.06 ± 318.94 g, respectively. We identified five echocardiographic variables along with gestational age that was independently associated with the outcome variable (PPI, LV output, Superior Mesenteric Artery [SMA] Velocity Time Integral [VTI], Peak diastolic flow velocity in Pulmonary Vein [PV Vd], and reversal of flow in diastole in descending aorta [DFR]). The range of severity score was 0 (low risk) to 12 (high risk). A higher score was associated with the primary outcome variable of CLD/death (7.5 [1.2] vs. 3.6 [1.5], p < 0.001). Our severity score had an area under the curve of 0.97 (95% CI 0.93−0.99, p < 0.001) for predicting CLD/death. Conclusion: Our new PDA severity score of 5.5 has a sensitivity and specificity of 94% and 93%, and positive and negative predictive values of 94% and 93%, respectively.
早产儿动脉导管未闭（PDA）与包括慢性肺病（CLD）及死亡在内的多种合并症相关。然而，PDA的治疗仍存在争议。此前已有多个超声心动图变量用于确定PDA的血流动力学意义，但其在临床结局早期预测中的效用尚未得到充分研究。目的：我们研究的目的是评估一种纳入体循环灌注不足、肺循环灌注过度及左心室（LV）功能标志物的严重程度评分系统在预测早产儿临床结局中的应用。方法：这是一项单中心前瞻性观察性研究，纳入孕周<32周的新生儿。在出生后7天内进行超声心动图检查，以测量先前已知可预测PDA分流严重程度的变量，包括肺灌注指数（PPI）。使用多因素逻辑回归确定CLD/死亡的预测因素。得出一个严重程度评分，并使用受试者工作特征曲线测试其预测临床结局的能力。结果：我们研究了98例婴儿，其平均（标准差）孕周为28.9±1.91周，出生体重为1228.06±318.94g。我们确定了五个超声心动图变量以及孕周，它们与结局变量独立相关（PPI、左心室输出量、肠系膜上动脉[SMA]速度时间积分[VTI]、肺静脉舒张末期峰值流速[PV Vd]以及降主动脉舒张期血流逆转[DFR]）。严重程度评分范围为0（低风险）至12（高风险）。较高的评分与CLD/死亡的主要结局变量相关（7.5[1.2]对3.6[1.5]，p<0.001）。我们的严重程度评分预测CLD/死亡的曲线下面积为0.97（95%CI 0.93−0.99，p<0.001）。结论：我们新的PDA严重程度评分为5.5，敏感性和特异性分别为94%和93%，阳性和阴性预测值分别为94%和93%。
