Table 1.
Clinical and Echocardiographic Criteria for Determining the Magnitude of a Hemodynamically Significant PDA
| Clinical Criteria | |
|---|---|
| C1 | Asymptomatic |
| C2 | Mild |
| Oxygenation difficulty (OI <6) | |
| Occasional (<6) episodes of oxygen desaturation, bradycardia, or apnea | |
| Need for respiratory support (nCPAP) or mechanical ventilation (MAP <8) | |
| Feeding intolerance (>20% gastric aspirates) | |
| Radiologic evidence of increased pulmonary vasoreactivity | |
| C3 | Moderate |
| Oxygenation difficulty (OI 7-14) | |
| Frequent (hourly) episodes of oxygen desaturation, bradycardia, or apnea | |
| Increasing ventilation requirements (MAP 9-12) | |
| Inability to feed due to marked abdominal distension or emesis | |
| Oliguria with mild elevation in plasma creatinine | |
| Systemic hypotension (low mean or diastolic BP) requiring a single cardiotropic agent | |
| Radiological evidence of cardiomegaly or pulmonary edema | |
| Mild metabolic acidosis (pH 7.1-7.25 and/or base deficit −7 to −12.0) | |
| C4 | Severe |
| Oxygenation difficulty (OI >15) | |
| High ventilation requirements (MAP >12) or need for high-frequency modes of ventilation | |
| Profound or recurrent pulmonary hemorrhage | |
| NEC-like abdominal distension with tenderness or erythema | |
| Acute renal failure | |
| Hemodynamic instability requiring >1 cardiotropic agent | |
| Moderate to severe metabolic acidosis (pH <7.1 or base deficit >−12.0) | |
| Echocardiographic Criteria | |
|---|---|
| E1 | No evidence of ductal flow on 2-dimensional or Doppler interrogation |
| E2 | Small nonsignificant ductus arteriosus |
| Transductal diameter <1.5 mm | |
| Restrictive continuous transductal flow (DA Vmax >2.0 m/s) | |
| No signs of left heart volume loading (eg, LA:Ao ratio >1.5:1) | |
| No signs of left heart pressure loading (eg, E/A ratio >1.0) | |
| Normal end-organ diastolic flow in superior mesenteric artery, middle cerebral artery, or renal artery | |
| E3 | Moderate hemodynamically significant PDA |
| Transductal diameter 1.5-3.0 mm | |
| Unrestrictive pulsatile transductal flow (DA Vmax <2.0 m/s) | |
| Mild to moderate left heart volume loading (eg, LA:Ao ratio 1.5-2:1) | |
| Mild to moderate left heart pressure loading (eg, E/A ratio >1.0) | |
| Decreased or absent end-organ diastolic flow in superior mesenteric artery, middle cerebral artery, or renal artery | |
| E4 | Large hemodynamically significant PDA |
| Transductal diameter >3.0 mm | |
| Unrestrictive pulsatile transductal flow | |
| Severe left heart volume loading (eg, LA:Ao ratio >2:1) | |
| Severe left heart pressure loading (eg, E/A ratio >1.5) | |
| Reversal of end-diastolic flow in superior mesenteric artery, middle cerebral artery, or renal artery | |
Patients should be assigned both a clinical (C1 to C4) and an echocardiographic (E1 to E4) stage.
Adapted From McNamara et al.8
BP = blood pressure; DA Vmax = ductus arteriosus peak velocity; E/A = early passive to late atrial contractile phase of transmitral filling ratio; LA:Ao = left atrium to aortic; MAP = mean airway pressure; nCPAP = nasal continuous positive airway pressure; NEC = necrotizing enterocolitis; OI = oxygenation index; PDA = patent ductus arteriosus.