Letter to the Editor Received: April 20, 2015 Accepted: April 23, 2015 Published online: June 10, 2015

Neonatology 2015;108:99 DOI: 10.1159/000430883

Future Benefits of Sequential Echocardiography: Unmasking the Indications for Treatment of Patent Ductus Arteriosus in Extremely Preterm Infants Karl Wilhelm Olsson Richard Sindelar Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden

sus. Twenty-nine (52%) had successful PDA closure (closed group) and 27 (48%) failed to close (persistent group) during treatment. Median time to treatment was 3 days in both groups. All newborn infants underwent serial echocardiographic within the first days of life. At the last examination before treatment, all infants had a predominately left to right ductal flow. There was no difference in the left atrium/aortic ratio (median: 1.5, range: 1.2–2.8 in the closed group, and median: 1.7, range: 1.1–3.5 in the persistent group, p = 0.198) or the ductal diameter (median: 1.7 mm, range: 0.9–3.0 in the closed group, and median: 1.8 mm, range: 1.0–3.0 in the persistent group, p = 0.399). The maximal ductal flow velocity was 1.6 m/s (range: 0.5–2.7) in the closed group and 1.1 m/s (range: 0.7–2.9) in the persistent group (p = 0.023). No other differences in clinical parameters or ventilator characteristics were observed before treatment. In the persistent group, 11 infants (41%) were subjected to surgery after follow-up echocardiography. Fifteen (52%) versus 16 (59%) infants were diagnosed with bronchopulmonary dysplasia (p  = 0.602) in the closed and persistent groups,

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respectively. Our study could not confirm any significant difference in outcome between infants whose PDA did or did not close during treatment. As previously stated by Gudmundsdottir et al. [1] and Professor Meyer, we also believe that serial echocardiography and an individualized approach are important in the assessment of PDA in preterm infants. Our study indicates that maximal ductal flow velocity could possibly be a parameter used to estimate the chances for treatment success in individual infants, but more information on the reliability of this parameter is needed.

References 1 Gudmundsdottir A, Johansson S, Håkansson S, Norman M, Källen K, Bonamy AK: Timing of pharmacological treatment for patent ductus arteriosus and risk of secondary surgery, death or bronchopulmonary dysplasia: a population-based cohort study of extremely preterm infants. Neonatology 2015;107:87–92. 2 Olsson KW, Jonzon A, Sindelar R: A high ductal flow velocity is associated with successful pharmacological closure of patent ductus arteriosus in infants 22–27 weeks gestational age. Crit Care Res Pract 2012;2012:715265.

Dr. Karl Wilhelm Olsson Department of Women’s and Children’s Health Uppsala University Children’s Hospital SE–751 85 Uppsala (Sweden) E-Mail karl_wilhelm.olsson @ kbh.uu.se

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Dear Sir, In their study published in Neonatology, Gudmundsdottir et al. [1] presented data on 290 infants born before 27 gestational weeks who had received pharmacological patent ductus arteriosus (PDA) treatment. The study demonstrated that the timing of treatment is not associated with the risk of secondary PDA surgery or death. In a responding letter, Professor Meyer stressed the need for echocardiographic data in this cohort to determine the indications for PDA treatment. In their reply, the authors stated that infants in the EXPRESS cohort most often underwent serial echocardiographic examinations before treatment, but that data were not available at the time of the study. In view of this, we would like to draw attention to previously published data on serial echocardiographic examinations from a one-center cohort overlapping the EXPRESS cohort in the paper by Gudmundsdottir et al. [1]. In our study [2] we presented data on infants born at 22–27 weeks of gestational age between January 2006 and December 2009 at Uppsala University Children’s Hospital. A total of 130 infants were born and 56 infants received pharmacological treatment for patency of the ductus arterio-

Future Benefits of Sequential Echocardiography: Unmasking the Indications for Treatment of Patent Ductus Arteriosus in Extremely Preterm Infants.

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