Comparison of clinical criteria with echocardiographic findings in diagnosing PDA in preterm infants

Objective: The purpose of our study was to compare clinical criteria with echocardiographic findings in diagnosing hemodynamically significant patent ductus arteriosus (PDA) in preterm infants. Methods: We evaluated 25 preterm infants born at 24-32 weeks of gestation with birth weight from 500 to 1700 g for tachycardia, heart murmur, hyperdynamic chest, presence of dorsalis pedis pulse,, hypotension, and worsening of the respiratory status at 48-72 h of life. A pediatric cardiologist blinded to clinical findings performed the echocardiograms. Infants with congenital anomalies and conditions, sepsis, IVH, and necrotizing enterocolitis were excluded. Results: Out of 25 preterm infants, 12 infants had hemodynamically significant PDA with left-to-right shunt. Two infants had small PDA and in 11 infants the ductus arteriosus was not patent. PDA infants had lower gestational age (P=0.02) and birth weight (P=0.03). Their Apgar scores (1 min) were lower (P=0.03). The heart rate between the two groups differed, but was clinically within normal limits. Systolic (P=0.05) and mean blood pressures (P=0.04) were lower in the PDA group. A poor association between heart murmur, hyperdynamic chest and dorsalis pedis pulse, and the presence of PDA was revealed. Conclusion: Echocardiogram is required for early diagnosis of PDA in preterm infants, as clinical signs are not reliable in the first few days of life.