PDA Management in the First Month in High-Risk Preterm Neonate Clinical Pathway — N/IICU and Inpatient

Clinical Assessment

Respiratory

Mild	Moderate	Severe
Oxygenation Index (OI) < 7	Oxygenation Index (OI) 7-14	Oxygenation Index (OI) > 14
Occasional episodes of oxygen desaturation, bradycardia or apnea	Frequent episodes of oxygen desaturation, bradycardia or apnea
Respiratory support nCPAP or MAP < 8	Moderate ventilatory requirement (MAP 9-12) or increase in respiratory support	High ventilatory requirement or HFV (MAP > 12) or pulmonary hemorrhage

Cardiovascular

Mild	Moderate	Severe
Increased pulmonary vascularity confirmed on CXR	Cardiomegaly or pulmonary edema confirmed on CXR
Widened pulse pressure > 20 mmHg	Systemic hypotension Low diastolic or mean BP requiring a single medication for BP support (cardiotropic agents or steroids)	Hemodynamic instability requiring > 1 medication for BP support (cardiotropic agents or steroids)

Acidosis

Mild	Moderate	Severe
Minimal acidosis	Unexplained worsening acidosis	Acidosis difficult to manage

End Organ

Moderate	Severe
Oliguria with plasma creatinine > 0.8	Renal failure
Feeding intolerance with abdominal distention or emesis	Concern for NEC

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.