Early echocardiographic prediction of ductal closure in neonates ⩽30 weeks gestation

Objective:to determine the accuracy of the patent ductus arteriosus:left pulmonary artery ratio (pda:lpa) on echocardiogram (echo) at 3-day postnatal in predicting spontaneous pda closure in neonates ⩽30 weeks gestational age (ga).study design:echos were performed at 72 h to characterize pda size as closed-to-small (pda:lpa <0.5) or moderate-to-large (pda:lpa ⩾0.5) and at 10 days to determine spontaneous closure (defined as closed-to-small in the absence of medical and/or surgical treatment). caretakers were blinded to results; treatment was based on standard care. neonates were prospectively enrolled and stratified: <27 weeks (n=31) and 27 to 30 weeks (n=65).result:neonates <27 weeks with closed-to-small pdas had 60% spontaneous closure vs 9% when moderate-to-large (positive predictive value (ppv) 60%, negative predictive value (npv) 91%). neonates 27 to 30 weeks had 95% spontaneous closure vs 27%, respectively (ppv 95%, npv 73%). inter-observer variability for the initial echo was 0.84.conclusion:pda size defined by pda:lpa at 3 days postnatal in combination with ga predicts spontaneous pda closure.