204 - Utilization of a PDA Scoring System in the VLBW Population to Predict Hemodynamically Significant PDA

Publication Number: 204.7017

Meyling Zuniga, Stony Brook Children's Hospital, Ronkonkoma, NY, United States; Jennifer Pynn, Stony Brook Children's Hospital, Stony Brook, NY, United States; Shanthy Sridhar, Stony Brook Children'S Hospital, Stony Brook, NY, United States

Background: Patent ductus arteriosus (PDA) poses significant risks in preterm neonates, necessitating accurate predictive tools for early detection and management. Standard practice includes bedside echocardiography to identify the presence of a hsPDA but prior to obtaining the study, determining patients at highest risk is essential. The SIMPLE scoring system was developed as a non-echocardiographic screening method to predict a hemodynamically significant PDA (hsPDA) in extremely low birth weight (ELBW) infants based on clinical risk factors. The utility of the SIMPLE score in the very low birth weight (VLBW) population as a tool to determine the need for medical or surgical closure has yet to be determined.

Objective: To evaluate the efficacy of the SIMPLE scoring system in predicting a hsPDA, defined as one needing medical or surgical treatment, in the VLBW population.

Design/Methods: A retrospective cohort study was approved by the Stony Brook Institutional Review Board. The study included VLBW neonates admitted to the Stony Brook Neonatal Intensive Care Unit (NICU) from 2019-2023 with an echocardiographic diagnosis of PDA. Antenatal and postnatal demographics were obtained from the electronic medical record. The SIMPLE score, based on 14 clinical parameters, was calculated within 72 hours of birth to predict the need for PDA treatment. Infants were classified into two groups: those with a hsPDA and those not requiring treatment. We analyzed the distribution of SIMPLE scores among the groups by calculating medians which were compared using t-tests and graphically represented using a whisker plot.

Results: A total of 110 VLBW patients were included in this study. Of the patients included 80% were delivered by cesarean section with a 64% male predominance and with a median gestational age and mean birth weight of 28 weeks and 918g ± 278g, respectively. Antenatal exposures included: 69% antenatal steroids, 84% antenatal magnesium and 19% indomethacin for preterm labor. Postnatally, 92% received any number of surfactant doses with 1/3 receiving 2 doses of surfactant. Forty-two percent of the patients received medical treatment for a hsPDA and 15% who failed medical treatment underwent surgical treatment. Calculated SIMPLE scores >13 were associated with any treatment for a hsPDA with median SIMPLE scores represented in Figure 1. The surgical treatment group reached statistical significance in comparison to no treatment.

Conclusion(s): The SIMPLE scoring system can be used in the VLBW population to help predict which patients are at highest risk for requiring medical and surgical management of their hsPDA.

Figure 1: Comparison of PDA Score for Treatment vs. No Treatment
*p < 0.05 is statistically significant

Figure 1: Comparison of PDA Score for Treatment vs. No Treatment
*p < 0.05 is statistically significant