Calculators/Apps by NeoCardioLab (and others)

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From the article: "The following equation was used to derive the risk score for each infant: (gestation in weeks × −1.304) + (PDA diameter in mm × 0.781) + (LVO in mL/kg/min × 0.008) + (maximum PDA velocity in m/s × −1.065) + (LV a′ wave in cm/s × −0.470) + 41, where 41 is the constant of the formula. This score ranges between 0 (low risk) and 13 (high risk). The predicted probability for each infant to develop CLD/death was also derived from the model. Infants without a PDA at the time of the scan were assigned a risk of 0 as a severity score cannot be derived from infants without a PDA diameter or maximum PDA velocity measurement."

References:

• El-Khuffash A, James AT, Corcoran JD, Dicker P, Franklin O, Elsayed YN, Ting JY, Sehgal A, Malikiwi A, Harabor A, Soraisham AS, McNamara PJ. A Patent Ductus Arteriosus Severity Score Predicts Chronic Lung Disease or Death before Discharge. J Pediatr. 2015 Dec;167(6):1354-1361.e2. doi: 10.1016/j.jpeds.2015.09.028. Epub 2015 Oct 21. PMID: 26474706.

• El-Khuffash A, Bussmann N, Breatnach CR, Smith A, Tully E, Griffin J, McCallion N, Corcoran JD, Fernandez E, Looi C, Cleary B, Franklin O, McNamara PJ. A Pilot Randomized Controlled Trial of Early Targeted Patent Ductus Arteriosus Treatment Using a Risk Based Severity Score (The PDA RCT). J Pediatr. 2021 Feb;229:127-133. doi: 10.1016/j.jpeds.2020.10.024. Epub 2020 Oct 16. PMID: 33069668.

• de Boode WP. Advanced Hemodynamic Monitoring in the Neonatal Intensive Care Unit. Clin Perinatol. 2020 Sep;47(3):423-434. doi: 10.1016/j.clp.2020.05.001. Epub 2020 May 21. PMID: 32713442.

  • "WHAT IS A NORMAL LEVEL OF CARDIAC OUTPUT? A ventricular output of 150 to 300 mL/kg/min is considered normal in (pre)term infants without transductal or interatrial shunting. A ventricular output less than 150 mL/kg/min or SVCf less than 40 to 45 mL/kg/min is associated with adverse outcomes. Although it would be preferred to measure cardiac output very accurately in absolute numbers, it might be more useful to categorize the level of cardiac output (low, normal, or high) for the purpose of understanding the underlying pathophysiology and when interpreted in conjunction with blood pressure for the classification of the stage of shock. The combination of low cardiac output and normal blood pressure would suggest a compensated shock, whereas low cardiac output and low blood pressure is indicative of an uncompensated shock. In a hyperdynamic shock, one would expect high cardiac output and low blood pressure. The interpretation of simultaneously assessed cardiac output and blood pressure enables an individualized, pathophysiology-based approach toward cardiocirculatory failure in critically ill newborn infants."

For the dp/dt of the LV, we use the CW-Doppler of the MR jet. Here it takes 10.56 msec to get from 1 m/s to 3 m/s. Here the dp/dt is 3030 mmHg/sec, well above the 1200 mmHg/sec threshold for LV systolic dysfunction

In comparaison, for the RV - we take the CW-Doppler of the TR jet. Here it takes 15.84 msec to go from 1 m/s to 2 m/s for the RV by the CW-Doppler of the TRJ. It represents 758mmHg/s, which is above ≥ 400 mmHg/s, likely normal.