Surgical closure of the patent ductus arteriosus and its effect on the cerebral tissue oxygenation

Vanderhaegen, Joke; Smet, Dominique De; Meyns, Bart; Velde, M. Van de; Huffel, Sabine Van; Naulaers, Gunnar

doi:10.1111/j.1651-2227.2008.01021.x

Cited by 46 publications

(27 citation statements)

References 30 publications

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“…During this early period, most ELBW infants have large PDA with massive shunt flow (left to right, right to left, or bidirectional). For example, LVCO in infants with significant LR shunt through large PDA may double compared with those without PDA, which influence CBF because of a stealing shunt flow from the descending aorta to the main pulmonary artery (35,36). However, the direction and the amount of the shunt flow often do not depend on the BP but on the pulmonary vascular resistance, which in turn, depends on the respiratory status.…”

Section: Discussionmentioning

confidence: 99%

Changes in cerebral perfusion in extremely low birth weight infants during the first 72 hours after birth

et al. 2010

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Cerebral perfusion and its relation with systemic circulation in extremely LBW (ELBW) infants in the early neonatal period are not well understood. The cerebral tissue oxygenation index (TOI) and cerebral fractional tissue oxygen extraction (FTOE) were monitored in stable 16 ELBW infants (GA Ͻ29 wk) using nearinfrared spectroscopy (NIRS) at 3-6, 12, 18, 24, 36, 48, and 72 h after birth. The left ventricular end-systolic wall stress (ESWS), left ventricular ejection fraction (LVEF), left ventricular cardiac output (LVCO), and superior vena cava (SVC) flow were also measured simultaneously using echocardiography. The ESWS increased till 18 h and then decreased; LVEF, LVCO, and SVC flow decreased till 12 h and increased thereafter. The TOI decreased till 12 h and correlated with SVC flow; FTOE increased until 12 h and then decreased. These changes in variables of NIRS and echocardiographic measurements contrasted to changes in mean arterial blood pressure (MABP), which showed trends of continuous and gradual increase after birth. We conclude that even stable ELBW infants undergo evident transitional changes in cerebral oxygenation and perfusion in the early postnatal period, which may reflect changes in cardiac function and cardiac output. T he survival rate of extremely LBW (ELBW) infants has markedly improved owing to advances in medical technology and patient management as well as better understanding of neonatal pathophysiology. However, cerebral complications remain a major problem causing long-term neurodevelopmental sequelae (1). Intraventricular hemorrhage (IVH) is known to occur in ELBW infants and is attributable to multiple pathogenetic factors including vulnerability of the vasculature and fragility of the germinal matrix of the brain (2). Hypotension and hypoperfusion of the brain during the immediate postnatal period have been reported to be related with cerebral damage in sick preterm infants (3-5). Kluckow and Evans (6) proposed Doppler echocardiographic measurement of blood flow in the superior vena cava (SVC) as a consistent marker of upper body perfusion, including cerebral blood flow (CBF). They reported that sick preterm infants who developed IVH experienced a period of low SVC flow within the first 48 h of life (7).Although some recent studies have found changes in cerebral oxygenation in very LBW (VLBW) infants (8,9) using near-infrared spectroscopy (NIRS), there have been no studies on longitudinal and detailed assessment of cerebral perfusion in ELBW infants in the early postnatal period. Furthermore, the relationship between cerebral perfusion, systemic perfusion, and arterial blood pressure during the immediate postnatal period is determined by multiple factors and has not been fully understood. The aim of this study was to characterize in detail the cerebral oxygenation and oxygen extraction, as determined by NIRS, and systemic blood flow and cardiac function, as evaluated by echocardiography, in ELBW infants during the early postnatal period. METHODSSubjects. ELBW infants (bir...

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Section: Discussionmentioning

confidence: 99%

Changes in cerebral perfusion in extremely low birth weight infants during the first 72 hours after birth

et al. 2010

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“…Studies have also shown that changes in DA flow may influence regional cerebral oxygen saturation very quickly. Vanderhaegen et al [20] found that 5 min after surgical closure of the PDA there was an increase of cerebral rSO 2 , which then disappeared by 20 min after clipping.…”

Section: Discussionmentioning

confidence: 99%

A Left-to-Right Shunt via the Ductus Arteriosus Is Associated with Increased Regional Cerebral Oxygen Saturation during Neonatal Transition

Urlesberger¹,

Brandner²,

Pocivalnik³

et al. 2013

Neonatology

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Background: Oxygen delivery to the brain is dependent on cardiac output and arterial oxygen content. Objectives: The study was designed to investigate the influence of a left-to-right shunt via the ductus arteriosus (DA) on regional oxygen saturation (rSO₂) of the brain and peripheral tissue during postnatal transition. Methods: Nested case-control study. In term neonates after elective cesarian section, rSO₂ of the brain and pre- and postductal peripheral tissue were measured 15 min after uncomplicated postnatal transition. Two groups were formed according to shunt flow characteristics via the DA: shunt group (with a left-to-right shunt), and nonshunt group (no shunt). Results: Of 80 infants, in 58 (72%) a left-to-right shunt was identified, and in 22 (28%) no flow was seen via the DA. The 22 infants formed the nonshunt group. They were matched with 22 newborn infants with a left-to-right shunt via the DA (shunt group). Infants in the nonshunt group had significantly lower cerebral rSO₂ values and higher fractional tissue oxygen extraction and heart rate values. There were no significant differences in regard to peripheral rSO₂ values. Conclusion: During postnatal transition, term infants with a left-to-right shunt via the DA have significantly higher cerebral rSO₂ values compared to infants without shunt flow.

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“…However, slower infusion rates did not have such an impact on brain haemodynamics [61]. Surgical closure of the PDA showed no consistent effects on cerebral circulation and oxygenation [53,54,55,56]. …”

Section: Interventions That Affect Oxygen Delivery To the Brainmentioning

confidence: 99%

“…The effect of a haemodynamically significant PDA or its treatment on cerebral haemodynamics and oxygenation is addressed in a number of studies using NIRS and other monitoring methods [46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61]. PDA may be a determinant in blood flow redistribution causing decreased blood pressure and rSt O 2 and increased FOE [57].…”

Section: Interventions That Affect Oxygen Delivery To the Brainmentioning

confidence: 99%

The SafeBoosC Phase II Randomised Clinical Trial: A Treatment Guideline for Targeted Near-Infrared-Derived Cerebral Tissue Oxygenation versus Standard Treatment in Extremely Preterm Infants

et al. 2013

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Near-infrared spectroscopy-derived regional tissue oxygen saturation of haemoglobin (rStO₂) reflects venous oxygen saturation. If cerebral metabolism is stable, rStO₂ can be used as an estimate of cerebral oxygen delivery. The SafeBoosC phase II randomised clinical trial hypothesises that the burden of hypo- and hyperoxia can be reduced by the combined use of close monitoring of the cerebral rStO₂ and a treatment guideline to correct deviations in rStO₂ outside a predefined target range. Aims: To describe the rationale for and content of this treatment guideline. Methods: Review of the literature and assessment of the quality of evidence and the grade of recommendation for each of the interventions. Results and Conclusions: A clinical intervention algorithm based on the main determinants of cerebral perfusion-oxygenation changes during the first hours after birth was generated. The treatment guideline is presented to assist neonatologists in making decisions in relation to cerebral oximetry readings in preterm infants within the SafeBoosC phase II randomised clinical trial. The evidence grades were relatively low and the guideline cannot be recommended outside a research setting.

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Surgical closure of the patent ductus arteriosus and its effect on the cerebral tissue oxygenation

Abstract: The ductal clipping in se has no negative effect on the cerebral oxygenation.

Cited by 46 publications

References 30 publications

Changes in cerebral perfusion in extremely low birth weight infants during the first 72 hours after birth

Changes in cerebral perfusion in extremely low birth weight infants during the first 72 hours after birth

A Left-to-Right Shunt via the Ductus Arteriosus Is Associated with Increased Regional Cerebral Oxygen Saturation during Neonatal Transition

The SafeBoosC Phase II Randomised Clinical Trial: A Treatment Guideline for Targeted Near-Infrared-Derived Cerebral Tissue Oxygenation versus Standard Treatment in Extremely Preterm Infants

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