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Cardiovascular Dysfunction Scoring System Based Ibuprofen Treatment for Patent Ductus Arteriosus in Preterm Infants: A Retrospective Cohort Study in a Leading Chinese Center

Background: The clinical efficacy of treatment strategies for patent ductus arteriosus (PDA) vary in part because of the lack of definitive evidenced based data. 
 
Methods: This retrospective cohort study included 3,014 preterm infants diagnosed with PDA according to the Cardiovascular Dysfunction Scoring System (CVDscore) and echocardiography. All infants were of a gestational age (GA) < 33 weeks and admitted to a tertiary neonatal intensive care unit. The participants were classified into six groups (A1, A2, A3, B1, B2, B3) based on CVDscores (A, < 3, and B, ≥ 3) and intervention (1, observation; 2, ibuprofen treatment within 24 h; and 3, ibuprofen treatment after 24 h). 
 
Findings: The incidence of PDA was 62.4%, which decreased with increased GA and birth weight. Participants with CVDscores < 3 all had PDA closure without the need for surgery, and ibuprofen treatment did not significantly affect PDA closure among the groups. Participants with CVDscores ≥ 3 had significant closure PDA rates even after 2 courses of treatment (64.3%), but nearly all patients required surgical treatment after the third course, and closure rates were significantly lower in the group that received ibuprofen within 24 h compared to the group that received ibuprofen after 24 h. The incidence of adverse events, including BPD, ROP, and IVH, increased with increased use of ibuprofen. 
 
Interpretation: The PDA CVDscore can be used as an alternative index for hemodynamic changes when bedside echocardiography is unavailable, which may have important implications for choosing PDA treatment strategies in preterm infants. Specifically, ibuprofen could be effective if given in 2 courses when the CVDscore is continuously ≥ 3. 
 
Funding Information: This work was supported by the National Natural Science Foundation of China (grant no. 30973210). 
 
Declaration of Interests: None declared. 
 
Ethical Approval Statement: This study was approved by the Medical Ethics Committee of the Clinical Medical College in PLA Army Hospital, and informed consent in writing was provided by the legal guardians of the VPIs (No: 2017.50).