Kindler et al reported a score for identifying a preterm neonate with hemodynamically-significant patent ductus arteriosus (PDA). This can help to identify a patient who requires more aggressive management. The authors are from TechnischeUniversitat Dresden in Germany.
The score is based on the model of Kabus.
Patient selection: preterm neonate with patent ductus arteriosus
Features of hemodynamically-significant patent ductus arteriosus:
(1) left-to-right shunt with pulmonary overflow
(2) steal phenomenon from the peripheral circulation with ischemia to internal viscera
(3) precordial pulsations and tachycardia
(4) hepatomegaly
(5) accentuated femoral pulses
(6) metabolic acidosis
(7) elevated natriuretic peptides
Parameters:
(1) pulsation of the precordium
(2) systolic murmur
(3) heart rate
(4) apnea or mechanical ventilation
(5) bounding femoral pulses
(6) hepatomegaly
(7) metabolic acidosis (arterial pH < 7.3, base excess less than -5 mmol/L)
(8) respiratory deterioration (increased oxygen supplementation; need for respiratory support; frequent apnea; increasing hypercapnia)
|
Parameter
|
Finding
|
Points
|
|
pulsation of the precordium
|
absent
|
0
|
|
|
present
|
1
|
|
systolic murmur
|
absent
|
0
|
|
|
present
|
1
|
|
heart rate
|
<= 160 pm
|
0
|
|
|
> 160 bpm (tachycardia)
|
1
|
|
apnea or mechanical ventilation
|
no
|
0
|
|
|
yes
|
1
|
|
bounding femoral pulses
|
no
|
0
|
|
|
yes
|
1
|
|
hepatomegaly
|
no
|
0
|
|
|
yes
|
1
|
|
metabolic acidosis
|
no
|
0
|
|
|
yes
|
1
|
|
respiratory deterioration
|
no
|
0
|
|
|
yes
|
1
|
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 8
• A score >= 2 is associated with hemodynamically significant PDA. Echocardiography should be performed.
