Patent ductus arteriosus and cystic periventricular leucomalacia in preterm infants

Abstract

Aim: To test the association between early disturbances in hemodynamics induced by left‐to‐right shunting through the duct and cystic periventricular leucomalacia. Patients: Forty‐six preterm infants (27–32 wk) admitted to the neonatal intensive care unit with risk criteria. Methods: Patent ductus arteriosus was evaluated on days 1 and 4, and was significant (sPDA) in cases of absent or reversed end diastolic flow in the subductal aorta. Resistance index was measured in the anterior cerebral artery and in the subductal aorta. Main outcome: Diagnosis of cystic periventricular leucomalacia between day 10 and day 50. Results: The 12 infants who developed cystic periventricular leucomalacia were compared with those who did not. On day 1, sPDA was more frequent (64% vs 26%; p= 0.03) in the cystic periventricular leucomalacia group, left ventricular output was higher (median = 341 vs 279mlkg‐1.min‐1; p= 0.005), and rescue surfactant was more frequently used (83% vs 47%; p= 0.03). This latter association was confirmed by multivariate analysis. Resistance index in the anterior cerebral artery was increased in cases of significant patent ductus arteriosus (p < 0.01) and was correlated with resistance index in the subductal aorta. Conclusion: On day 1 in this selected population, sPDA has an effect on blood flow velocity waveform in cerebral arteries and is associated with an increase in the emergence of cystic periventricular leucomalacia. This association could be casual rather than causal.

Late‐onset circulatory dysfunction of premature infants and late‐onset periventricular leukomalacia

“…The intensive care of preterm neonates has advanced during the past decade, and the increasing rate of survival for extremely low‐birthweight infants also increases the importance of improving the neurological prognosis. Nevertheless, periventricular leukomalacia (PVL) remains the main cause of cerebral palsy in preterm infants, even though many risk factors for PVL have been identified, including hypocarbia, 1–5 sepsis, 6 premature rupture of membranes, 7–9 chorioamnionitis, 7–10 prematurity, 7 asphyxia, multiple gestation, maternal hemorrhage, respiratory distress syndrome, intraventricular hemorrhage (IVH), 6 and patent ductus arteriosus (PDA) 11 …”

Surgical closure of patent ductus arteriosus reduces the cerebral tissue oxygenation index in preterm infants: a near‐infrared spectroscopy and Doppler study

“…1,2 PDA allows a back-fl ow from the systemic circulation to the pulmonary artery, which can affect cerebral blood fl ow (CBF) and lead to ischemic or haemorrhagic lesions in newborn infants. 3,4 Haemodynamic changes due to PDA blood fl ow stealing have been reported in the retrograde fl ow within the pulmonary artery 5 and descending aorta. 6 A lower diastolic fl ow rate in the anterior cerebral artery (ACA), 7,8 an increased pulsatility index (PI) 9 and resistance index (RI) 10 have also been reported.…”

Primer consenso clínico de SIBEN: enfoque diagnóstico y terapéutico del ductus arterioso permeable en recién nacidos pretérmino

“…Diferentes estudios han evaluado la repercusión del DAP-HS clínicamente "silencioso" en el desarrollo o extensión de HIV o leucomalacia periventricular (LPV) en el cerebro del niño prematuro 138,160,216,217,[219][220][221][222] . El DAP se asoció estadísticamente con la presencia o con la extensión de la HIV en algunos estudios 216,221 , pero no en otros 217,219,222 . En un estudio 221 , la normalización del flujo a la vena cava superior (VCS) como indicador indirecto del flujo sanguíneo cerebral (FSC), coincidió con la aparición de HIV tardía, lo que apoyaría la teoría de la isquemia-reperfusión en la etiopatogenia de la HIV.…”

“…En un estudio 221 , la normalización del flujo a la vena cava superior (VCS) como indicador indirecto del flujo sanguíneo cerebral (FSC), coincidió con la aparición de HIV tardía, lo que apoyaría la teoría de la isquemia-reperfusión en la etiopatogenia de la HIV. Estudios observacionales también apoyan la asociación entre DAP y lesión isquémica 217,219,222 , con una relación significativa entre bajo flujo y resultados adversos como muerte, HIV, ECN y alteraciones del neurodesarrollo a los 3 años de vida 32, 216,217,222 . El bajo flujo de la VCS en las primeras 24 h de vida se asoció con discapacidad, y por cada incremento del flujo de 10 ml/kg/min, la probabilidad de muerte o discapacidad se reducen en un 28 % 223 .…”