Abstract Objective To explore the predictive factors for hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants and to construct a nomogram prediction model for hsPDA occurrence in this population. Methods A retrospective analysis was conducted on the clinical data of preterm infants with gestational age <32 weeks diagnosed with patent ductus arteriosus (PDA) who were delivered at Nanjing Women and Children's Healthcare Hospital from January 2020 to December 2022. The subjects were divided into an hsPDA group (52 cases) and a non-hsPDA group (176 cases) based on the presence of hsPDA. Univariate analysis and multivariate logistic regression analysis were performed to screen predictive variables regarding the general information of the infants at birth, maternal pregnancy and delivery conditions, and relevant indicators during hospitalization. A nomogram prediction model for hsPDA occurrence was constructed using R software in preterm infants. Internal validation was performed using the Bootstrap method. Finally, the predictive model was evaluated for calibration, discrimination ability, and clinical utility. Results Multivariate regression analysis showed that the ratio of the left atrium to aorta diameter (LA/AO), mode of delivery (vaginal), and duration of mechanical ventilation were independent predictive factors for hsPDA in preterm infants (P<0.05). Based on the results of univariate analysis and multivariate logistic regression analysis, variables used to construct the nomogram prediction model for hsPDA risk included: LA/AO ratio, mode of delivery (vaginal), duration of mechanical ventilation, 5-minute Apgar score, and the presence of neonatal respiratory distress syndrome requiring surfactant therapy. The area under the receiver operating characteristic curve for this model was 0.876 (95%CI: 0.824-0.927), and the calibrated curve was close to the ideal reference line, indicating good calibration. The Hosmer-Lemeshow test demonstrated that the model fit well, and the clinical decision curve was above the extreme curves. Conclusions The nomogram prediction model, constructed using five variables (LA/AO ratio, vaginal delivery, duration of mechanical ventilation, 5-minute Apgar score, and the presence of neonatal respiratory distress syndrome requiring surfactant therapy), has reference significance for predicting the occurrence of hsPDA in preterm infants and provides valuable guidance for the early clinical identification of hsPDA.
MU Jun,LI Shu-Shu,SU Ai-Ling et al. Predictive factors for hemodynamically significant patent ductus arteriosus in preterm infants and the construction of a nomogram prediction model[J]. CJCP, 2025, 27(3): 279-285.
MU Jun,LI Shu-Shu,SU Ai-Ling et al. Predictive factors for hemodynamically significant patent ductus arteriosus in preterm infants and the construction of a nomogram prediction model[J]. CJCP, 2025, 27(3): 279-285.
Deshpande P, Baczynski M, McNamara PJ, et al. Patent ductus arteriosus: the physiology of transition[J]. Semin Fetal Neonatal Med, 2018, 23(4): 225-231. PMID: 29779927. DOI: 10.1016/j.siny.2018.05.001.
5 Clyman RI. Patent ductus arteriosus in the preterm infant[M]//Gleason CA, Devaskar SU. Avery's Diseases of the Newborn. 9th ed. Philadelphia: W.B. Saunders, 2012: 751-761.
Conrad C, Newberry D. Understanding the pathophysiology, implications, and treatment options of patent ductus arteriosus in the neonatal population[J]. Adv Neonatal Care, 2019, 19(3): 179-187. PMID: 30720481. DOI: 10.1097/ANC.0000000000000590.
Shepherd JL, Noori S. What is a hemodynamically significant PDA in preterm infants?[J]. Congenit Heart Dis, 2019, 14(1): 21-26. PMID: 30548469. DOI: 10.1111/chd.12727.
de Boode WP, Kluckow M, McNamara PJ, et al. Role of neonatologist-performed echocardiography in the assessment and management of patent ductus arteriosus physiology in the newborn[J]. Semin Fetal Neonatal Med, 2018, 23(4): 292-297. PMID: 29551482. DOI: 10.1016/j.siny.2018.03.007.
Hsu KH, Nguyen J, Dekom S, et al. Effects of patent ductus arteriosus on organ blood flow in infants born very preterm: a prospective study with serial echocardiography[J]. J Pediatr, 2020, 216: 95-100.e2. PMID: 31610928. DOI: 10.1016/j.jpeds.2019.08.057.
Engür D, Deveci M, Türkmen MK. Early signs that predict later haemodynamically significant patent ductus arteriosus[J]. Cardiol Young, 2016, 26(3): 439-445. PMID: 25826049. DOI: 10.1017/S1047951115000372.
Willis KA, Weems MF. Hemodynamically significant patent ductus arteriosus and the development of bronchopulmonary dysplasia[J]. Congenit Heart Dis, 2019, 14(1): 27-32. PMID: 30343505. DOI: 10.1111/chd.12691.
Kim ES, Kim EK, Choi CW, et al. Intrauterine inflammation as a risk factor for persistent ductus arteriosus patency after cyclooxygenase inhibition in extremely low birth weight infants[J]. J Pediatr, 2010, 157(5): 745-750.e1. PMID: 20598319. DOI: 10.1016/j.jpeds.2010.05.020.
Nutritional Committee of Neonatology Branch of Chinese Medical Doctor Association; Preterm Committee of Neonatology Branch of Chinese Medical Doctor Association; Editorial Committee of Chinese Journal of Contemporary Pediatrics. Expert consensus on parenteral nutrition management in neonates (2025)[J]. CJCP, 2025, 27(3): 247-261.
Neonatal Clinical Practice Guidelines Expert Committee of the Cross-Strait Medical and Health Exchange Association; Neonatal Evidence-Based Medicine Group of the Commission of Neonatal Medicine of the Cross-Strait Medical and Health Exchange Association; Editorial Office of the C. Clinical practice guidelines for the diagnosis and treatment of anemia of prematurity (2025)[J]. CJCP, 2025, 27(1): 1-17.
Nutritional Committee of Neonatology Branch of Chinese Medical Doctor Association; Preterm Committee of Neonatology Branch of Chinese Medical Doctor Association; Editorial Committee of Chinese Journal of Contemporary Pediatrics. Expert consensus on enteral nutrition management of preterm infants (2024)[J]. CJCP, 2024, 26(6): 541-552.
[15]
FAN Yu-Wei, ZHANG Yi-Jia, WEN He-Mei, YAN Hong, SHEN Wei, DING Yue-Qin, LONG Yun-Feng, ZHANG Zhi-Gang, LI Gui-Fang, JIANG Hong, RAO Hong-Ping, QIU Jian-Wu, WEI Xian, ZHANG Ya-Yu, ZENG Ji-Bin, ZHAO Chang-Liang, XU Wei-Peng, WANG Fan, YUAN Li, YANG Xiu-Fang, LI Wei, LIN Ni-Yang, CHEN Qian, XIA Chang-Shun, ZHONG Xin-Qi, CUI Qi-Liang. Risk factors for bronchopulmonary dysplasia in twin preterm infants: a multicenter study[J]. CJCP, 2024, 26(6): 611-618.
