028 - Standardizing Patent Ductus Arteriosus Management in Preterm Infants Through Early Targeted Echocardiogram and PDA Scoring Tool: A Multidisciplinary Quality Improvement Initiative

Publication Number: 28.6871

Dilli R. Bhurtel, Children's Hospital of Richmond at VCU, Glen Allen, VA, United States; Christopher R. Chow, Virginia Commonwealth University School of Medicine, Richmond, VA, United States; Kelly Stanley, Children's Hospital of Richmond at VCU, Henrico, VA, United States; Miheret S. Yitayew, Children's Hospital of Richmond at VCU, Richmond, VA, United States

Background: The management of patent ductus arteriosus (PDA) in preterm infants varies widely across neonatal intensive care units (NICUs), influenced by inconsistent screening practices and differing definitions of hemodynamically significant PDA. In our Level IV NICU, which frequently cares for extremely preterm infants, we found common inconsistencies in PDA management. Echocardiograms were often delayed until clinical signs of PDA were evident, usually around end of first week of life and after. The use of comprehensive echocardiograms with subjective interpretations by cardiologists without standardized metrics further complicated care. To address these challenges, we performed a multidisciplinary quality improvement initiative using an early targeted echocardiogram and PDA hemodynamic significance scoring system (Iowa protocol).

Objective: This initiative aimed to standardize echocardiographic screening and interpretation, improve consistency in PDA severity assessments through a scoring system, and facilitate informed treatment decisions based on objective data.

Design/Methods: A multidisciplinary PDA task force, consisting of neonatologists and pediatric cardiologists, implemented the early targeted echocardiography and PDA significance scoring tool. Training sessions were conducted for clinical team members, covering protocol details and standardized terminology. Laminated protocol copies were distributed for consistent reference. The project utilized the Plan-Do-Study-Act (PDSA) quality improvement methodology, with ongoing feedback to optimize protocol adherence. Data collected included clinical characteristics, imaging timing, duration of echocardiograms, and adherence to guidelines. We compared a one-year baseline period Jan,2022 -Feb,2023 with a one-year post-intervention period Mar,2023 – Mar,2024 using descriptive statistics.

Results: Data from 52 infants in the baseline period and 56 post-interventions indicated that treatment protocol adherence reached nearly 100%, with the IOWA score reported in 80% of cases. Targeted echocardiograms increased by 32% from baseline and were mostly obtained within 48 hours of life. Scan times were reduced by over 50%. With increased early screening we noted increase in treatment of PDA cases per treatment protocol without variation.

Conclusion(s): PDA screening and management in preterm infants can be inconsistent, but standardization is achievable through interdisciplinary collaboration, early targeted echocardiography, and established PDA scoring systems, even without a dedicated neonatal hemodynamics team.

PDA management pre-Quality improvement initiative & Driver Diagram
PDA QI PDA management and QI Driver Diagram.pdf

Targeted Echo and PDA scoring protocol
Quality initiative -Targeted Echo and PDA scoring Protocol.pdf

Demographic and Clinical Characteristics of preterm infants
Pre and Post QI data.pdf