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Cerebral oxygenation and echocardiographic parameters in preterm neonates with a patent ductus arteriosus: an observational study
  1. Laura Dix1,
  2. Mirella Molenschot2,
  3. Johannes Breur2,
  4. Willem de Vries1,
  5. Daniel Vijlbrief1,
  6. Floris Groenendaal1,
  7. Frank van Bel1,
  8. Petra Lemmers1
  1. 1Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
  2. 2Department of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
  1. Correspondence to Laura Dix, Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center, Room KE04.123.1, PO Box 85090, Utrecht 3584AE, The Netherlands; l.m.l.dix-2{at}umcutrecht.nl

Abstract

Background A haemodynamically significant patent ductus arteriosus (hsPDA) is clinically suspected and confirmed by echocardiographic examination. A hsPDA decreases cerebral blood flow and oxygen saturation by the ductal steal phenomenon.

Aim To determine the relationship between echocardiographic parameters, cerebral oxygenation and a hsPDA in preterm infants.

Methods 380 preterm infants (<32 weeks gestational age) born between 2008 and 2010 were included. Blinded echocardiographic examination was performed on the second, fourth and sixth day after birth. Examinations were deblinded when hsPDA was clinically suspected. Regional cerebral oxygen saturation (rScO2) was continuously monitored by near-infrared spectroscopy during 72 h after birth, and afterwards for at least 1 h before echocardiography. Echocardiographic parameters included ductal diameter, end-diastolic flow in the left pulmonary artery, left atrium/aorta ratio and ductal flow pattern.

Results rScO2 was significantly related only to ductal diameter over time. Mixed modelling analysed the course of rScO2 over time, where infants were divided into four groups: a closed duct, an open haemodynamically insignificant duct (non-sPDA), a hsPDA, which was successfully closed during study period (SC hsPDA) or a hsPDA, which was unsuccessfully closed during study period (UC hsPDA). SC hsPDA infants showed the highest rScO2 on day 6, while UC hsPDA infants had the lowest rScO2 values.

Conclusions Ductal diameter is the only echocardiographic parameter significantly related to cerebral oxygenation over time. Cerebral oxygenation takes a different course over time depending on the status of the duct. Low cerebral oxygenation may be suggestive of a hsPDA.

  • preterm infants
  • cerebral oxygenation
  • patent ductus arteriosus
  • echocardiography
  • near infrared spectroscopy

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