Cerebral Hemodynamics Are Not Affected by the Size of the Patent Ductus Arteriosus

Abstract

Introduction: Although patent ductus arteriosus (PDA) has been implicated to play a role in the development of cerebral ischemia and intraventricular hemorrhage (IVH) through a cerebral steal phenomenon, there is conflicting data on the impact of PDA size on cerebral blood flow (CBF). Cerebral autoregulation is the brain's innate protective mechanism to maintain constant CBF despite changes in blood pressure, and it is unclear if it is influenced by PDA hemodynamics. Objective: To delineate the relationship between PDA size and CBF velocity (CBFv) in premature infants. Methods: 113 premature infants born at 23-29 weeks' gestation had echocardiograms performed during the first week after birth to evaluate for PDA. The infants were divided into 3 groups according to PDA size: none-to-small, moderate, or large. All infants had continuous recordings of umbilical artery blood pressure (ABP) and CBFv during the first week after birth. Critical closing pressure (CrCP) was calculated from ABP and CBFv tracings. Diastolic closing margin (DCM), defined as di-astolic blood pressure minus CrCP, was calculated as a marker for the risk of developing IVH. Results: Infants with a large PDA (n = 16) had the lowest ABP across all phases of the cardiac cycle (systole [p = 0.003], mean [p = 0.005], and diastole [p = 0.012]) compared to infants with a moderate (n = 19) or none-to-small PDA (n = 78). Despite blood pressure being different, systolic, mean, and diastolic CBFv were not different across groups. Cerebral autoregulation, as measured during systole, was intact regardless of the PDA size. CrCP and DCM were also not different across groups. Conclusions: In this cohort, CBFv and cerebral autoregulation during systole were not influenced by PDA size. Intact cerebral autoregulation may play a role in maintaining CBFv regardless of PDA size and differences in ABP.

Change and clinical significance of serum cortisol, BNP, and PGE-2 levels in premature infants with patent ductus arteriosus

“…Cortisol is a stress hormone secreted by the adrenal cortex, which can be affected by infection, asphyxia, and other critical conditions (14). Previous studies used gestational age and prenatal dexamethasone as matching conditions, and found that the level of cortisol was related to the occurrence of PDA in premature infants (15,16). However, the influence mechanism of cortisol on the closure of the arterial catheter is unclear (17).…”

Echocardiography-Guided Management of Preterms With Patent Ductus Arteriosus Influences the Outcome: A Cohort Study

“…In addition, the presence of confounders may have influenced the results of these studies. Kim et al designed a cohort study including newborns with GA <29 weeks to assess the relation between the size of PDA and cerebral hemodynamics within the 1st week of life ( 45 ). They indicated that cerebral hemodynamics was found to be stable regardless of the size of PDA in those premature infants.…”

The prediction of estimated cerebral perfusion pressure with trans-systolic time in preterm and term infants

“…CrCP gradually increases at a rate of 1.4 mmHg per week in premature infants [4]. Moreover, CrCP in infants has been used to assess changes in cerebral perfusion due to patent ductus arteriosus and predict intraventricular haemorrhage [5,6]. However, insertion of an arterial line is invasive and di cult, especially in premature infants.…”