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Can a clinical decision rule help ductus arteriosus management in preterm neonates?

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Aim:  Patent ductus arteriosus (DA) occurs frequently in premature neonates with respiratory distress syndrome. We assessed a combination of clinical, biological and echocardiographic parameters to derive a decision rule for selecting candidates for treatment based on the criteria in use in our unit.

Methods:  Hundred and forty neonates with a mean (SD) gestational age of 28 (2.3) weeks and a mean birth weight of 1159 (386) g, all requiring invasive ventilation with FiO2 > 0.3 or catecholamines for severe hypotension, were assessed prospectively using echocardiography in conjunction with N‐terminal pro‐B‐type natriuretic peptide (NTpBNP) levels within 24–72 h of birth. Independent predictors of DA treatment were identified with univariate analysis and combined in a clinical decision rule.

Results:  Early treatment of significant DA was adopted for 26 (18.6%) neonates. A clinical decision rule suggesting treatment in patients with NTpBNP > 8500 pg/mL, ductal diameter >1.5 mm and, for infants with a birth weight >830 g, left pulmonary artery end‐diastolic velocity >0.20 m/sec showed 88% sensitivity and 94% specificity.

Conclusions:  A decision rule using realistic and/or commonly used parameters for significant patent ductus arteriosus assessment could be derived. External validation of this rule is needed before any application.
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Document Type: Research Article

Affiliations: 1: .Neonatology Department, Arnaud de Villeneuve Hospital, CHU Montpellier, France 2: .Department of Biochemistry, Lapeyronie Hospital, CHU Montpellier, France

Publication date: 2012-05-01

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