The definition of a haemodynamic significant duct in randomized controlled trials: a systematic literature review

Abstract

Aim: A patent ductus arteriosus (PDA) is associated with morbidity in preterm infants. Treatment is prescribed for a haemodynamically significant duct (HSDA), but its definition varies. We systematically reviewed the clinical and ultrasound criteria used for the definition of an HSDA. Methods:PubMed and the Cochrane library were searched for randomized trials evaluating ductal treatment. The included studies were explored, and we categorized clinical and ultrasound criteria used to define an HSDA.Results: Sixty-seven trials were included in our review. Forty-two were placebo-controlled trials, and 25 were comparative trials. The diagnosis of the PDA was made by clinical examination, followed by ultrasound in most trials. Most trials used clinical and ultrasound criteria to define an HSDA, but there was a wide variety in criteria and cut-offs used. Of the clinical criteria, a murmur or hyperdynamic circulation was most used, and of the ultrasound criteria, the left-atrium-to-aorta ratio (LA ⁄ Ao ratio) was most used.

Platelet Counts and Patent Ductus Arteriosus in Preterm Infants: A Systematic Review and Meta-Analysis

“…These uncertainties have resulted in different definitions of what investigators have called ‘significant PDA', i.e. one that causes symptoms or is worthy of treatment [3,4,31,32]. We noted marked differences in the rates of PDA/SPDA reported in the studies included in our meta-analysis (table 1).…”

Which Criteria are More Valuable in Defining Hemodynamic Significance of Patent Ductus Arteriosus in Premature Infants? Respiratory or Echocardiographic?

“…Clinical (respiratory signs, physical signs, blood pressure problems, congestive heart failure signs) and echocardiographic (LA:Ao>1.30 and DD>1.5-2 mm) criteria were commonly used to define hsPDAs (10). Unfortunately, the optimal criteria for defining hsPDA are lacking and there is a wide variety of strategies used in different clinics (12).…”

“…The decision whether, when, or how to administer therapies to close PDA in premature infants remains challenging (9). Treatment is commonly prescribed for hsPDA (10).…”

“…Most centers use clinical criteria [(a) respiratory signs, including increased respiratory support, failure to wean from respiratory support or O 2 need; (b) physical signs, including murmurs, hyperdynamic precordium or bounding pulses; (c) blood pressure problems, including decreased mean or diastolic pressure or increased pulse pressure; (d) signs of congestive heart failure, including cardiomegaly, hepatomegaly or pulmonary congestion] and echocardiographic criteria [(a) a left atrial-to-aortic root diameter ratio of >1.30 (LA:Ao); (b) a ductus diameter (DD) of >1.5-2 mm] to define hsPDA but there is a wide variety of strategies used in different clinics (10).…”

Aneurysm of the left atrium in a child with patent ductus arteriosus and mitral valve prolapse

“…There is a clear indication of late immediate surgical treatment with echocardiographic monitoring aspect of the left atrium and mitral valve function [1,2]. SURGERY During monitoring, it was possible to observe the clinical symptoms, with significant bulging chest to the left ( Figure 4).…”