Development of a Diagnostic Clinical Score for Hemodynamically Significant Patent Ductus Arteriosus

Figures

• 

  Figure 1. Flowchart of the clinical approach to diagnose a clinical relevant hemodynamically significant persistent ductus arteriosus (hsPDA) using clinical parameters and echocardiography. The scoring tool was used in all premature neonates equal or less than 31 weeks of gestation. In all preterm infants GA <28 weeks or BW <1,000 g, an initial echocardiography was performed between 48 and 72 h of life, in addition to the clinical score. All other premature neonates GA ≥28 weeks were assessed by clinical scoring and received an echocardiography only if the score was ≥2 points. GA, gestational age; BW, birth weight.

• 

  Figure 2. (A,B) Sensitivity and specificity of the clinical PDA score. Using multivariate logistic regression analysis (daily) and receiver operating characteristic (ROC) (29) curves, we compared the power of combinations of particular features and determined the sensitivity and specificity (dependent on the determined cutoff-level). The theoretical optimal cutoff-level was 1.5 points. (C) Screening of the validity of the clinical score. We tested to see if the score of ≥2 points was able to discriminate between the two groups with and without hsPDA. For the presence of a parameter we increased the number of points from 1 to 2 or 3. The frequency of the given points at day 4 of the score is shown as an example. On the upper part the infants without hsPDA are shown, those with hsPDA are shown on the lower part. Newborns with hsPDA usually reached a score of 2 or more points.