title: A Patent Ductus Arteriosus Severity Score Predicts Chronic Lung Disease or Death before Discharge.
abstract: OBJECTIVE
  To test the hypothesis that a patent ductus arteriosus (PDA) severity score (PDAsc) incorporating markers of pulmonary overcirculation and left ventricular (LV) diastolic function can predict chronic lung disease or death before discharge (CLD/death).
  
  
  METHODS
  A multicenter prospective observational study was conducted for infants <29 weeks gestation. An echocardiogram was carried out on day 2 to measure PDA diameter and maximum flow velocity, LV output, diastolic flow in the descending aorta and celiac trunk, and variables of LV function using tissue Doppler imaging. Predictors of CLD/death were identified using logistic regression methods. A PDAsc was created and a receiver operating characteristic curve was constructed to assess its ability to predict CLD/death.
  
  
  RESULTS
  We studied 141 infants at a mean (SD) gestation and birthweight of 26 (1.4) weeks and 952 (235) g, respectively. Five variables were identified that were independently associated with CLD/death (gestation at birth, PDA diameter, maximum flow velocity, LV output, and LV a' wave). The PDAsc had a range from 0 (low risk) to 13 (high risk). Infants who developed CLD/death had a higher score than those who did not (7.3 [1.8] vs 3.8 [2.0], P < .001). PDAsc had an area under the curve of 0.92 (95% CI 0.86-0.97, P < .001) for the ability to predict CLD/death. A PDAsc cut-off of 5 has sensitivity and specificity of 92% and 87%, and positive and negative predictive values of 92% and 82%, respectively.
  
  
  CONCLUSIONS
  A PDAsc on day 2 can predict the later occurrence of CLD/death further highlighting the association between PDA significance and morbidity.
authors.affiliation: Department of Neonatology, The Rotunda Hospital, Dublin, Ireland; Department of Pediatrics, The Royal College of Surgeons in Ireland, Dublin, Ireland. Electronic address: afifelkhuffash@rcsi.ie.
authors.forename: Afif
authors.initials: A
authors.lastname: El-Khuffash
authors.affiliation: Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.
authors.forename: Adam T
authors.initials: AT
authors.lastname: James
authors.affiliation: Department of Neonatology, The Rotunda Hospital, Dublin, Ireland; Department of Pediatrics, The Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: John David
authors.initials: JD
authors.lastname: Corcoran
authors.affiliation: Department of Biostatistics, The Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Dicker
authors.affiliation: Department of Pediatric Cardiology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.
authors.forename: Orla
authors.initials: O
authors.lastname: Franklin
authors.affiliation: Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Yasser N
authors.initials: YN
authors.lastname: Elsayed
authors.affiliation: Department of Pediatrics, University of British Columbia, Vancouver, British Colombia, Canada.
authors.forename: Joseph Y
authors.initials: JY
authors.lastname: Ting
authors.affiliation: Monash Newborn, Monash Children's Hospital, Melbourne, Australia; Department of Pediatrics, Monash University, Melbourne, Australia.
authors.forename: Arvind
authors.initials: A
authors.lastname: Sehgal
authors.affiliation: Monash Newborn, Monash Children's Hospital, Melbourne, Australia.
authors.forename: Andra
authors.initials: A
authors.lastname: Malikiwi
authors.affiliation: Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Andrei
authors.initials: A
authors.lastname: Harabor
authors.affiliation: Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Amuchou S
authors.initials: AS
authors.lastname: Soraisham
authors.affiliation: Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Departments of Physiology and Pediatrics, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: McNamara
mesh_terms: D001315:Australia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D002423:Cause of Death / Q000639:trends; D002908:Chronic Disease; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D015150:Echocardiography, Doppler; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D007494:Ireland / Q000453:epidemiology; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D008297:Male; D010351:Patient Discharge; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve