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Observational Study
. 2025 Sep;18(5):456-466.
doi: 10.1177/19345798251349744. Epub 2025 Jul 24.

Reliability of comprehensive echocardiography evaluation of patent ductus arteriosus among extremely preterm neonates across a national network: A prospective observational study

Dany E Weisz  1   2 , Laura Thomas  1   3 , Xiang Y Ye  4 , Luc Mertens  2   5 , Anie Lapointe  6 , Andréanne Villeneuve  6 , Gabriel Altit  7 , Renjini Lalitha  8 , Nadya Ben Fadel  9 , George Jacob  1 , Deepak Louis  10 , Soume Bhattacharya  8 , Amuchou Soraisham  11 , Audrey Hébert  12 , Souvik Mitra  13 , Abbas Hyderi  14 , Joseph Y Ting  14 , Michael Castaldo  15 , Aimann Surak  14 , Poorva Deshpande  2   3 , Yasser Elsayed  15 , Bonny Jasani  16 , Sagee Nissimov  2 , Faith Zhu  2 , Prakesh Shah  2   3   4 , Amish Jain  2   3
Affiliations
Observational Study

Reliability of comprehensive echocardiography evaluation of patent ductus arteriosus among extremely preterm neonates across a national network: A prospective observational study

Dany E Weisz et al. J Neonatal Perinatal Med. 2025 Sep.

Abstract

BackgroundPrior studies on the reliability of targeted neonatal echocardiography (TNE) among extremely low gestational age neonates (ELGANs) with a patent ductus arteriosus (PDA) have been limited to evaluation of pre-defined images by a small set of study observers. The objective of this study was to investigate the interobserver reliability of comprehensive echocardiography measures of PDA size/shunt volume and ventricular performance among TNE-neonatologists in a large national network.MethodsWe conducted a prospective observational study. TNEs performed for the evaluation of PDA among ELGANs were analyzed by TNE-neonatologists from the Canadian TNE Consortium. Analyses were conducted via an interactive videoconferencing platform offering full remote control to the review software. Reliability for continuous measures was evaluated using the intraclass correlation coefficient (ICC) and coefficient of variation. The kappa statistic was used to evaluate the interobserver reliability of categorical parameters.ResultsReliability was excellent among indices of PDA size and gradient (ICC≥0.91) and good-to-excellent among most indices of left ventricular (LV) size and output (ICC≥0.79, except for LV end-systolic volume and left atrium to aortic root ratio). There was substantial to near-complete agreement on PDA shunt direction and diastolic flow abnormalities in the abdominal aorta and systemic arteries (kappa ≥0.78). However, reliability for measures of LV systolic and diastolic performance was variable with ICC range 0.21-0.95, though with low coefficient of variation (<15%).ConclusionsInterobserver reliability for most TNE measures of PDA size, gradient, shunt volume, and LV dimensions and function is good-to-excellent, supporting the validity of incorporating these indices in prospective multicenter research.

Keywords: PDA; TNE; coefficient of variation; intraclass correlation coefficient; kappa statistic; patent ductus arteriosus; premature; targeted neonatal echocardiography.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Graphical plot of the set of the estimates of PDA diameter for each of the 12 echocardiograms analyzed in the study, demonstrating the range of PDA sizes and variability in estimates.
Figure 2.
Figure 2.
Spearman correlation of the intraclass correlation coefficient and number of measurements omitted per echocardiography parameter.
See this image and copyright information in PMC

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