Effects of patent ductus arteriosus on left ventricular output and organ blood flows in preterm infants with respiratory distress syndrome treated with surfactant

Factors affecting postnatal changes in serum creatinine in preterm infants with gestational age <32 weeks

“…Vanpée et al 26 showed that sick VLBW infants having a PDA and requiring mechanical ventilation had lower creatinine clearances and significantly higher fractional sodium excretion than controls; however, their study also included few infants who had received NSAID for ductus closure before evaluating renal function. Shimada et al 27,28 studied the cardiocirculatory effects of hsPDA in VLBW and extremely low BW preterm with RDS and they found a significant decrease in renal blood flow in infants with hsPDA compared to controls before pharmacological closure of Figure 1 Creatinine profile during the first week of life according to gestational age (GA) in 652 infants <32 weeks of GA. Creatinine changes in preterm infants S Iacobelli et al PDA. Abnormal renal blood flows reverted after treatment and seemed less severe when early pharmacological closure of PDA was carried out.…”

Patent ductus arteriosus in the preterm infant: to treat or not to treat?

“…12 This association is even more prominent in the extremely preterm infants with mild or no respiratory distress syndrome. 13 With regard to the central nervous system, although some investigators have reported no change in cerebral blood flow (CBF) as a result of compensatory increase in cardiac output, 14 most studies have found CBF to be impaired in preterm infants with a PDA. [15][16][17][18][19] Doppler studies have shown that the negative effect of PDA on CBF mainly affects the blood flow during diastole, as evidenced by a decrease in flow velocity and increase in pulsatility or resistance index.…”

“…24 As far as gastrointestinal system is concerned, studies have consistently shown a reduction in intestinal blood flow in the presence of a PDA as evidenced by reduced abdominal aorta and superior mesenteric artery (SMA) blood flow assessed by Doppler ultrasonography. 14,17,25,26 The decrease in blood flow occurs despite the increase in left ventricular output. 14 Observations in animal experiments support the findings of Doppler studies in humans.…”

“…14,17,25,26 The decrease in blood flow occurs despite the increase in left ventricular output. 14 Observations in animal experiments support the findings of Doppler studies in humans. [27][28][29] In the preterm lamb, presence of even a small PDA defined by a shunt equal to 40% of the left ventricular output reduced the intestinal blood flow, and the magnitude of reduction in blood flow was inversely related to PDA size.…”

Diameter of the ductus arteriosus as a predictor of patent ductus arteriosus (PDA)

“…PDA impairs the perfusion of numerous organs [13], particularly in the abdomen (steal syndrome within the intestines and kidneys) and the nervous system. In the central nervous system PDA is associated with an increased risk of bleeding and leucomalatia around the cerebral ventricles [14].…”