Early colour Doppler duct diameter and symptomatic patent ductus arteriosus in a cyclo-oxygenase inhibitor naïve population

AIMS: To examine the relationship between early duct diameter and patent ductus arteriosus (PDA) symptoms.

METHODS: A retrospective study of infants <29 weeks of gestation with early colour Doppler assessment of PDA diameter, in whom PDA was managed conservatively, without cyclo-oxygenase inhibitor (COI) treatment.

RESULTS: Gestation and birthweight, [median (range)], were 26 (23-28) weeks and 865 (500-1440) g, respectively. Symptomatic PDA developed in 20 (68.9%) infants, with 11 (37.9%) referred for PDA ligation at 24 (17-30) days. Symptoms resolved spontaneously in 7 infants (24.1%) at 19 (7-32) days. There were 6 (20.7%) deaths, including four early neonatal deaths with large PDA. Early colour Doppler PDA diameter >1.5 mm (n = 20) predicted development of symptomatic PDA (sensitivity 91%, specificity 100%), but symptoms resolved spontaneously without treatment in 30%. There was a significant linear correlation (p < 0.001) with increasing early PDA diameter and the development of more persistent PDA symptoms, early neonatal mortality and morbidity.

CONCLUSIONS: In our (COI)-naïve population, the mortality and morbidity associated with prolonged exposure to unrestricted ducts are high. Not all infants with early PDA diameter >1.5 mm have persistent symptomatic PDA, but early PDA diameter could be utilized to identify those infants at greatest risk of adverse outcome associated with PDA.