A Patent Ductus Arteriosus Severity Score Predicts Chronic Lung Disease or Death before Discharge

J Pediatr. 2015 Dec;167(6):1354-1361.e2. doi: 10.1016/j.jpeds.2015.09.028. Epub 2015 Oct 21.


Objectives: To test the hypothesis that a patent ductus arteriosus (PDA) severity score (PDAsc) incorporating markers of pulmonary overcirculation and left ventricular (LV) diastolic function can predict chronic lung disease or death before discharge (CLD/death).

Study design: A multicenter prospective observational study was conducted for infants <29 weeks gestation. An echocardiogram was carried out on day 2 to measure PDA diameter and maximum flow velocity, LV output, diastolic flow in the descending aorta and celiac trunk, and variables of LV function using tissue Doppler imaging. Predictors of CLD/death were identified using logistic regression methods. A PDAsc was created and a receiver operating characteristic curve was constructed to assess its ability to predict CLD/death.

Results: We studied 141 infants at a mean (SD) gestation and birthweight of 26 (1.4) weeks and 952 (235) g, respectively. Five variables were identified that were independently associated with CLD/death (gestation at birth, PDA diameter, maximum flow velocity, LV output, and LV a' wave). The PDAsc had a range from 0 (low risk) to 13 (high risk). Infants who developed CLD/death had a higher score than those who did not (7.3 [1.8] vs 3.8 [2.0], P < .001). PDAsc had an area under the curve of 0.92 (95% CI 0.86-0.97, P < .001) for the ability to predict CLD/death. A PDAsc cut-off of 5 has sensitivity and specificity of 92% and 87%, and positive and negative predictive values of 92% and 82%, respectively.

Conclusions: A PDAsc on day 2 can predict the later occurrence of CLD/death further highlighting the association between PDA significance and morbidity.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Australia / epidemiology
  • Canada / epidemiology
  • Cause of Death / trends
  • Chronic Disease
  • Ductus Arteriosus, Patent / complications
  • Ductus Arteriosus, Patent / diagnosis*
  • Ductus Arteriosus, Patent / mortality
  • Echocardiography, Doppler
  • Female
  • Hospital Mortality / trends
  • Humans
  • Infant
  • Infant Mortality / trends
  • Infant, Newborn
  • Ireland / epidemiology
  • Lung Diseases / diagnosis
  • Lung Diseases / etiology*
  • Lung Diseases / mortality
  • Male
  • Patient Discharge*
  • Prognosis
  • Prospective Studies
  • ROC Curve