title: Can a clinical decision rule help ductus arteriosus management in preterm neonates?
abstract: OBJECTIVE
  Patent ductus arteriosus (DA) occurs frequently in premature neonates with respiratory distress syndrome. We assessed a combination of clinical, biological and echocardiographic parameters to derive a decision rule for selecting candidates for treatment based on the criteria in use in our unit.
  
  
  METHODS
  Hundred and forty neonates with a mean (SD) gestational age of 28 (2.3) weeks and a mean birth weight of 1159 (386) g, all requiring invasive ventilation with FiO(2) > 0.3 or catecholamines for severe hypotension, were assessed prospectively using echocardiography in conjunction with N-terminal pro-B-type natriuretic peptide (NTpBNP) levels within 24-72 h of birth. Independent predictors of DA treatment were identified with univariate analysis and combined in a clinical decision rule.
  
  
  RESULTS
  Early treatment of significant DA was adopted for 26 (18.6%) neonates. A clinical decision rule suggesting treatment in patients with NTpBNP > 8500 pg/mL, ductal diameter >1.5 mm and, for infants with a birth weight > 830 g, left pulmonary artery end-diastolic velocity >0.20 m/sec showed 88% sensitivity and 94% specificity.
  
  
  CONCLUSIONS
  A decision rule using realistic and/or commonly used parameters for significant patent ductus arteriosus assessment could be derived. External validation of this rule is needed before any application.
authors.affiliation: Neonatology Department, Arnaud de Villeneuve Hospital, CHU Montpellier, France. g-cambonie@chu-montpellier.fr
authors.forename: Gilles
authors.initials: G
authors.lastname: Cambonie
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Dupuy
authors.forename: Clémentine
authors.initials: C
authors.lastname: Combes
authors.forename: Marie
authors.initials: M
authors.lastname: Vincenti
authors.forename: Renaud
authors.initials: R
authors.lastname: Mesnage
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Cristol
mesh_terms: D019468:Disease Management; D004374:Ductus Arteriosus, Patent / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000628:therapy*; D018579:Patient Selection; D011446:Prospective Studies