VALUES OF CLINICAL CRITERIA COMPARED WITH ECHOCARDIOGRAPHIC FINDINGS IN DIAGNOSING OF PDA IN PREMATURE NEONATES

Patent ductus arteriosus (PDA) is common in premature neonates and can
cause adverse complications such as intraventricular hemorrhage (IVH), necrotizing enterocolitis
(NEC), and bronchopulmonary dysplasia in neonates. The purpose of this study was to evaluate
the validity of clinical criteria in diagnosing of PDA in premature neonate.
Methods |& Materials: This study was conducted on 61 premature neonates born between 24 to
34 weeks of gestation and with birth weight from 500 to 2100 grams including clinical signs such
as tachycardia, heart murmur, hyperdynamic chest, presence of dorsalis pedis pulse, hypotension
and worsening of respiratory status at 48-72 hours after birth. Echocardiographic evaluations were
done by a pediatric cardiologist blinded to clinical findings. Neonates with sepsis, IVH, congenital
anomalies, congenital heart diseases and NEC were excluded from the study.
Results: From all 61 premature neonates who entered this study 14 neonates had
hemodynamically significant PDA with left to right shunt ( PDA+). In five neonates PDA was
small and in 42 neonates ductus arteriosus was not patent (collectively PDA-). From clinical
criteria who evaluated, heart murmur, heart rate, presence of dorsalis pedis pulse, systolic and
diastolic blood pressures between two groups had not differences in statistical analysis. But the
number of neonates who had hyperdynamic precordium and worsening of respiratory status in 4872
h
of

life was more in PDA+ group. And this difference in statistical analysis was meaningful.
(P = 0.01)
Conclusions: Clinical signs are not reliable and sufficient for early diagnosing of PDA in
premature neonates; routine echocardiography must be done for this purpose. From clinical signs
hyperdynamic precordium and worsening respiratory status at 48-72 h of life have high sensitivity.
in addition, in conjunction with echocardiography are helpful for early diagnosing of PDA in
premature neonates