What makes a PDA haemodynamically significant?

A duct is considered significant when it causes a meaningful left-to-right shunt and volume load on the heart. Key markers are a larger ductal diameter, an LA:Ao ratio above about 1.5, and a clinical picture of worsening respiratory or circulatory status, especially in very preterm infants.

How does this estimator weight the features?

Ductal diameter and LA:Ao ratio carry the most points because they directly reflect shunt magnitude. Extreme prematurity, very low weight, and high levels of respiratory support add further points. The total maps to a suggested management tier.

Why does postnatal age change the suggestion?

Indomethacin and ibuprofen close the duct most reliably in the first one to two weeks of life. Beyond about three weeks pharmacological closure is much less effective, so the tool shifts the suggestion toward surgical or device referral when the infant is older.

When is pharmacological closure contraindicated?

NSAID closure is avoided with significant renal impairment, low platelets or active bleeding, and necrotising enterocolitis. If you flag a contraindication the tool moves a pharmacological candidate toward surgical referral, since drug treatment is not safe.

Is this a validated clinical score?

No. It is a structured aggregator to support team discussion, not a published or validated decision rule. Many units now manage even significant ducts conservatively. Every treatment decision must be made by the neonatal and cardiology team for the individual baby.

Neonatal PDA Treatment Candidacy Estimator

Deciding whether and how to treat a patent ductus arteriosus in a preterm infant is one of the more contested judgements in neonatology. This estimator gathers the features clinicians routinely weigh into one structured view to support that discussion.

How it works

The tool assigns points across recognised markers of a haemodynamically significant duct and respiratory burden, then maps the total to a management tier:

ductal diameter >= 2.0 mm        +3
LA:Ao ratio >= 1.8               +3
high-frequency ventilation       +3
gestational age < 26 weeks       +3
... lesser thresholds            +1 / +2 each

score <= 3   -> conservative
score 4-7    -> pharmacological closure
score >= 8   -> surgical / device referral

Two overrides then apply. If the infant is more than three weeks old, the pharmacological window has largely closed and the suggestion shifts to surgical referral. If you flag an NSAID contraindication such as renal failure, thrombocytopenia, necrotising enterocolitis or active bleeding, a pharmacological candidate is likewise moved to surgical referral because drug closure is unsafe.

Important notes

This is deliberately a feature aggregator, not a validated score. The evidence base has moved strongly toward conservative management in recent years, and many significant ducts close spontaneously without intervention. Treat the output as a prompt for the right conversation, never as an instruction. Choice between indomethacin, ibuprofen, paracetamol, surgical ligation and transcatheter device closure depends on local expertise, the infant’s full clinical trajectory and joint neonatal-cardiology assessment.