210 - Assessment of a Hemodynamic PDA with Objective Measures

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 210
Publication Number: 210.329

Sinead Brady, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States; Tina A. Leone, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Diana Vargas, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Federica Picozzi-Akke, Mount Sinai Hospital, New York, NY, United States

Presenting Author(s)

Sinead Brady, MD (she/her/hers)

Fellow
NewYork-Presbyterian Morgan Stanley Children's Hospital
New York, New York, United States

Background: Treatment of a patent ductus arteriosus(PDA) in premature infants is controversial. Persistence of a PDA has frequently been associated with significant neonatal morbidities that are associated with both the hemodynamic effects of increased pulmonary blood flow (eg. chronic lung disease (CLD)) and decreased systemic blood flow (eg. Necrotizing enterocolitis (NEC)). However, randomized controlled trials of PDA treatment have not demonstrated an improvement in morbidities such as CLD or NEC. Targeting treatment to the infants most severely affected by the hemodynamic effects of a PDA might provide a more useful treatment strategy. A PDA severity score (PDAsc) has been shown to correlate well with the clinical outcomes of CLD or death before hospital discharge. Electrical impedance cardiometry and troponin levels have also been shown to correlate with other echocardiographic markers of PDA significance.

Objective: We aimed to determine whether a hemodynamically significant PDA (hsPDA) as measured by PDAsc was associated with higher troponin values and cardiac index measured by cardiometry.

Design/Methods:

This is a single center prospective observational study that enrolled infants born at or below 30 weeks gestation after parental consent was obtained. On DOL 5, a full echocardiogram was performed and the PDAsc was calculated. A PDAsc indicated a hsPDA if it was greater than or equal to 6. Cardiometry was performed prior to and after the echocardiogram, and a troponin level was collected within 12 hours of the echocardiogram. Cardiometry values and troponin values in subjects with and without a hemodynamically significant PDAsc were compared using Students t-test or Mann Whitney test as appropriate.

Results: A total of 17 patients have been recruited at this time with a mean gestational age of 27 weeks (SD 1.7) and a mean birthweight of 974 grams (SD 298.8). Within this group, 7 subjects had hsPDA by PDAsc, and 3 received treatment for the PDA. Within the group that had hsPDA, the median troponin was 193 ng/L (IQR 147) and within the group with non-significant PDAsc the median troponin was 122 ng/L (IQR 106), p< 0.07. The average cardiac index as determined by electric impedance cardiometry was 833 ml/min/m² (SD 529) for the patients with hsPDA and 237 ml/min/m² (SD 40) for the those without hsPDA, p< 0.007.

Conclusion(s): These preliminary results suggest that electric impedance cardiometry can be a useful tool in helping to identify patients with hsPDA. Further investigation is needed to determine if troponin can be utilized to identify this population.