223 The Definition of a Hemodynamic Significant Duct in Randomised Controlled Trials, a Systematic Literature Review

Abstract

The ductus arteriosus is associated with morbidity in preterm infants. Treatment is prescribed for a hemodynamically significant duct (HSDA), but its definition varies. We systematically reviewed published clinical and ultrasound definitions (US) of a HSDA.

Methods: Pubmed and the Cochrane library were searched for randomised trials on ductal closure or trials evaluating the prevention of a symptomatic duct developing.

Results: Fifty nine trials were included in our review. Thirty nine trials used clinical and US criteria to define a HSDA, 5 trials clinical criteria only, 10 trials US criteria only, 2 trials clinical or US criteria and in 3 trials the criteria were not mentioned. Re-entry criteria for ductal assessment was clinical only (2), clinical followed by ultrasound (39), US only (3) or it was not mentioned (15). Clinical criteria were defined in 41 trials, with murmur (29), bounding pulses (27), hyperdynamic precordium (24), cardiomegaly (19) and respiratory status (19) most reported on. US criteria were defined in 50 trials, with LA/Ao ratio > 1.15 to 1.7 being most reported (33). Other US criteria used were flow pattern in the descending aorta (12) and in the pulmonary artery (13), or any left-right shunt (9). Ductal diameter < 1.5 mm was used in 8 more recent trials, but in only one trial as solitary US criteria.

Conclusion: A large variation in HSDA definition exists. We should try reaching an international consensus on the definition of a HSDA, and evaluate if clinical signs are correlated with the mentioned US parameters or DAd.

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