A blinded comparison of clinical and echocardiographic evaluation of the preterm infant for patent ductus arteriosus

J Paediatr Child Health. 1994 Oct;30(5):406-11. doi: 10.1111/j.1440-1754.1994.tb00689.x.


The accuracy of the characteristic physical signs of a patent ductus arteriosus (PDA), that is, a systolic murmur, increased volume of pulses and increased praecordial activity, in diagnosing a haemodynamically significant PDA in ventilated premature infants was prospectively evaluated. Fifty-five ventilated preterm infants (birthweight < 1500 g) had daily echocardiographic and clinical evaluation for a PDA for the first 7 days of life. The examiners were blinded to each other's findings. Probability analysis was performed for the accuracy of each clinical sign in detecting a haemodynamically significant PDA as defined by echocardiographic criteria. Clinical signs were poor at detecting a significant PDA in the first 4 days of life. On day 1, none of the 10 infants with a significant PDA had a murmur. By day 4, clinical signs were better at detecting a significant PDA, but specificity remained poor with many false positive signs. Six infants had murmurs with a closed duct. The development of echocardiographic haemodynamic significance preceded the development of physical signs by a mean of 1.8 days. Significant ductal shunts often occurred silently, but the development of a murmur often marked an increase in the velocity of the flow through the duct rather than an increase in the size of a shunt. This study confirms that echocardiography is required for the reliable early diagnosis of a PDA in ventilated preterm infants.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Ductus Arteriosus, Patent / diagnostic imaging*
  • Ductus Arteriosus, Patent / physiopathology
  • Echocardiography
  • Hemodynamics
  • Humans
  • Infant, Newborn
  • Infant, Premature*
  • Sensitivity and Specificity
  • Single-Blind Method