Early Postnatal Echocardiography Combined With Lung Ultrasound Score Predicted Sustained Opening Of HsPDA

Objective:To investigate the predictive value of early bedside cardiography and lung ultrasound score in identifying children with persistent hemodynamically significant patent ductus arteriosus hs PDA at 14 days postnatally.Methods:Very low birth weight infants hospitalized in the Neonatology Department of the First Hospital of Jilin University from June,2019 to June,2020 were retrospectively selected and divided into hs PDA and non-hs PDA groups based on bedside echocardiographic indices and clinical manifestations at 14 days after birth,and the influencing factors associated with sustained opening of hs PDA,echocardiographic parameters at 3 days after birth,lung ultrasound score(The clinical data,such as Lung Ultrasound Score(LUSsc)and routine blood parameters within 24 hours after birth,were analyzed to find the factors affecting the persistent opening of hs PDA,and the Receiver Operator Characteristic(ROC)curves were drawn to find the factors predicting the persistent opening of hs PDA at 14 days after birth.The best echocardiographic indexes and LUSsc cut-off values for predicting sustained hs PDA opening at 14 days postnatal were found.Results:1.The differences in gestational age,birth weight,1-minute Apgar score,5-minute Apgar score,cesarean section rate,PS application rate,days of mechanical ventilation,glucocorticoid application and vasoactive drug application between the two groups were statistically significant(P<0.05).The differences in the incidence of neonatal infection,sepsis,pneumonia,and pulmonary hemorrhage were statistically significant(P<0.05).The differences in the percentage of lymphocytes(LY%),red blood cell(RBC),and hemoglobin(HGB)in the postnatal 24 hours blood count were statistically significant(P<0.05).The differences in echocardiographic PDA diameter,left atrial internal diameter to aortic root diameter ratio(LA/AO),left ventricular ejection fraction(EF%),and lung ultrasound score(LUSsc)at 3 days after birth were statistically significant(P<0.05).2.PDA diameter at 3 days postnatal(OR(odds ratio)=5.063,95% CI(confidence interval): 1.498 to 17.112),LUSsc(OR(odds ratio)=1.375,95% CI(confidence interval): 1.092 to 1.731)were independent risk factors for sustained opening of hs PDA at 14 days postnatal(p<0.05),and HGB(OR(odds ratio)=0.133,95% CI(confidence interval): 0.019 to0.941)was an independent risk factor for protective factor for sustained opening of hs PDA at 14 days after birth(P<0.05).3.ROC curve showed that PDA diameter at 3 days postnatal,LA/AO,EF% and LUSsc were all effective predictors of sustained opening of hs PDA at 14 days postnatal(P<0.05).The AUC of PDA diameter at 3days postnatal echocardiography was 0.691 with a cutoff value of 2.55(sensitivity 0.77,specificity 0.58);the AUC of LA/AO was 0.668 with a cutoff value of 1.36(sensitivity 0.68,specificity 0.68);the AUC of EF%was 0.631 with a cutoff value of 73.5%(sensitivity 0.47,specificity 0.8),The AUC for LUSsc was 0.730 with a cut-off value of 8.5(sensitivity0.676,specificity 0.719).The highest diagnostic efficacy was achieved with the combination of echocardiographic indices at 3 days postnatal with LUSsc.Conclusions:1.PDA diameter,LA/AO,EF% on postnatal 3 days echocardiogram and LUSsc were all valid predictors of sustained PDA opening in preterm infants at 14 days postnatal.2.PDA diameter >2.55 mm,LA/AO >1.36,EF <73.5% on the 3 days postnatal echocardiogram and LUSsc >8.5 points are highly sensitive and specific for predicting sustained opening of hs PDA at 14 days postnatal in preterm infants,and have the highest combined predictive diagnostic efficacy at this time.