Abstract:
Introduction. Persistent ductus arteriosus (PDA) is the most common cardiac anomaly in premature infants and is a significant cause of early and late morbidity and mortality.
Material and methods. The study was conducted on 163 prematurely born children with a body weight of less than 1500 g and a gestational age of less than 32 weeks of gestation. Children with hz PDA were selected based on the transverse diameter of the PDA ≥1mm and were examined echocardiographically in the first 72 hours. Children from the examined group were divided into two subgroups: premature children with extremely low birth weight (ELBW) up to 1000 g and very low birth weight (VLBW) of 1001-1500 g.
Results. The frequency of hemodynamically significant PDA (HsPDA) is inversely proportional to the gestational age of premature babies. Gestational age, BW, as well as the absolute diameter of the PDA are not reliable parameters for predicting spontaneous closure or pharmacotreatment of PDA. The mean absolute diameter of the ductus was 2.14 ± 0.05 mm in ELBW children and 2.05 ± 0.72 mm in VLBW children. Indexing the ductus size according to body weight showed a higher value in ELBW than VLBW children (3.05 ± 0.35 mm/kg vs. 2.35 ± 0.65 mm/kg).
Conclusion. Our results confirmed that HsPDA can develop in the presence of a ductus >1.85 mm as an absolute value or >1.65 mm/kg indexed by body weight or >1.55 mm/BSA indexed by body surface area. Ductal diameter indexed to body surface area or body weight in preterm infants with VLBW and ELBW may more accurately predict spontaneous closure or the need for pharmacotherapy, compared to the absolute value of ductal diameter. Indexing according to weight showed a slightly higher sensitivity and specificity in both examined groups. This could facilitate the prediction of morbidity and mortality of premature children with hz PDA and prevent short-term or long-term consequences.
Key words: ductus arteriosus, premature children, medical treatment of hemodynamically significant PDA, mortality, ductal shunt indexing according to body surface area and body weight.
