Specialist Registrar Children's Health Ireland Dublin, Dublin, Ireland
Background: Neonatal acute kidney injury is common in premature infants and is associated with poor clinical outcomes. The presence of a patent ductus arteriosus is associated with a ‘ductal steal’ of systemic circulation, which can compromise perfusion of vital organs. Existing literature fails to measure the haemodynamic significance of a ductus, often arbitrarily using one isolated measure across a broad range of birth weights, to characterise the effect of the ductus on end-organ perfusion. The El-Khuffash PDA Severity Score combines clinical and echocardiographic parameters to assign a comprehensive measure of haemodynamic significance to a PDA. It uses gestational age at birth, ductal diameter, left ventricular output, PDA Vmax and left ventricular a’ to create a score between 0 and 13, with scores greater than or equal to 5 deemed high risk. Objective: This study aims to test the hypothesis that infants with a haemodynamically significant patent ductus arteriosus (hsPDA) have a higher incidence of acute kidney injury (AKI). Design/Methods: This was a single-centre study of infants < 29 weeks’ gestation at the Rotunda Hospital, Dublin, Ireland. The El-Khuffash PDA severity score was applied to patients following a haemodynamic echocardiographic assessment performed on day of life two. Biochemical, clinical, and echocardiographic data were collated for all participants. Mann Whitney U and Chi square tests were utilised to assess for association between individual characteristics and the primary outcome of AKI. Results: We report a cohort of n=86 infants with a PDA of a mean (standard deviation) gestation of 27 (1) weeks and a mean birth weight of 957g (235g). Ten (11.6%) of infants developed AKI.No single echocardiographic parameter in isolation was associated with AKI. The presence of a high-risk PDA score was independently associated with the occurrence of AKI.
Conclusion(s): Ductal diameter in isolation is redundant as a measure of haemodynamic significance. A high-risk El-Khuffash PDA score is associated with AKI in infants with PDA. Further work to ascertain echocardiographic predictors of AKI in this cohort is needed.
