Reduction in Cerebral Oxygenation due to Patent Ductus Arteriosus Is Pronounced in Small-for-Gestational-Age Neonates

Abstract

Background: A haemodynamically significant patent ductus arteriosus (hsPDA) reduces cerebral oxygenation in appropriate-for-gestational-age (AGA) preterm neonates. Reduced cerebral oxygenation has been associated with brain injury. Preterm small-for-gestational-age (SGA) neonates show higher cerebral oxygenation than AGA peers throughout the first postnatal days. To date, no studies have investigated the effect of hsPDA on cerebral oxygenation in preterm SGA neonates. Objective: We aimed to assess the effect of hsPDA on cerebral oxygenation in preterm SGA neonates compared to AGA peers. We hypothesised that higher baseline cerebral oxygenation would reduce the impact of hsPDA on cerebral oxygenation in preterm SGA neonates. Methods: We monitored regional cerebral oxygen saturation (rScO₂) with near-infrared spectroscopy and calculated the cerebral fractional tissue oxygen extraction (cFTOE) for 72 h after birth. Retrospective analysis compared 36 preterm SGA neonates (birth weight <10th percentile, 18 with hsPDA) to 36 preterm AGA neonates (birth weight 20th to 80th percentile, 18 with hsPDA). Results: In contrast to the other groups, SGA-hsPDA neonates demonstrated a significant fall in rScO₂ [69% (SEM 2.5) at 4-8 h to 61% (2.7) at 68-72 h, p < 0.001] with a concurrent rise in cFTOE [0.26 (0.026) at 4-8 h to 0.34 (0.030) at 68-72 h, p < 0.001]. Conclusions: Contrary to our hypothesis, hsPDA had a significant negative effect on cerebral oxygenation in preterm SGA neonates. Future studies should explore the potential benefits of early screening and treatment for hsPDA on long-term neurodevelopmental outcome in preterm SGA neonates.

Elevated renal tissue oxygenation in premature fetal growth restricted neonates: An observational study

“…Another limitation is that renal NIRS parameters have not yet been linked to renal function parameters, which is difficult due to the lack of renal function measurements especially during the first three days after birth. Persistent ductus arteriosus might have influenced our results, as previous studies report abnormal renal Doppler patterns [ 37 , 38 ] and reduced cerebral oxygenation around 72 hours after birth in preterm neonates with persistent ductus arteriosus [ 39 , 40 ]. An ultrasound to assess left ventricular cardiac output and persistent ductus arteriosus (with shunt direction) at the time of renal ultrasound would have helped to better interpret the results.…”

Therapeutic potential to reduce brain injury in growth restricted newborns

“…; Cohen et al . ). There have only been a handful of studies reporting 18–24 months follow‐up data for ibuprofen treatment for PDA (see Table ).…”

Monitoring Cerebral Oxygenation in Neonates: An Update

“…However, this does not necessarily protect against cerebral injury, and infants born following IUGR are at an increased risk of neurodevelopmental impairment (84, 85). In case of a PDA, SGA infants demonstrated a significantly larger fall in cerebral oxygenation, as compared to AGA infants (86). …”