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
- near infrared spectroscopy
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Contributors LD: collected data, performed analysis and wrote both the main as the revised manuscript. MM: conceptualising study concept, collected data, critically revised content of manuscript. HB: conceptualising study concept, collected data, critically revised content of manuscript. WdV: conceptualising study concept, critically revised content of manuscript. DV: conceptualising study concept, critically revised content of manuscript. FG: statistics FVB: conceptualising study concept, critically revised content of manuscript. PL: conceptualising study concept, data collection, critically revised content of manuscript. Final responsibility for manuscript content.
Competing interests None declared.
Patient consent Obtained.
Ethics approval Medical Ethical Committee of the UMC Utrecht.
Provenance and peer review Not commissioned; externally peer reviewed.