Early colour Doppler duct diameter and symptomatic patent ductus arteriosus in a cyclo-oxygenase inhibitor naive population

Aims To examine the relationship between early duct diameter and patent ductus arteriosus (PDA) symptoms. Methods A retrospective study of infants <29weeks of gestation with early colour Doppler assessment of PDA diameter, in whom PDA was managed conservatively, without cyclo-oxygenase inhibitor (COI) treatment. Results Gestation and birthweight, [median (range)], were 26 (2328) weeks and 865 (5001440) g, respectively. Symptomatic PDA developed in 20 (68.9%) infants, with 11 (37.9%) referred for PDA ligation at 24 (1730) days. Symptoms resolved spontaneously in 7 infants (24.1%) at 19 (732) days. There were 6 (20.7%) deaths, including four early neonatal deaths with large PDA. Early colour Doppler PDA diameter >1.5mm (n=20) predicted development of symptomatic PDA (sensitivity 91%, specificity 100%), but symptoms resolved spontaneously without treatment in 30%. There was a significant linear correlation (p<0.001) with increasing early PDA diameter and the development of more persistent PDA symptoms, early neonatal mortality and morbidity. Conclusions In our (COI)-naive population, the mortality and morbidity associated with prolonged exposure to unrestricted ducts are high. Not all infants with early PDA diameter >1.5mm have persistent symptomatic PDA, but early PDA diameter could be utilized to identify those infants at greatest risk of adverse outcome associated with PDA.