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Haemodynamically significant patent ductus arteriosus impairs cerebral oxygenation and may be linked with intraventricular haemorrhage

Presented at the Neonatal Society 2015 Autumn Meeting.

Kotidis C1,2, Subhedar N1, Weindling AM2, Turner M1,2

1 Neonatal unit, Liverpool Women’s Hospital, Liverpool, UK
2 Department of Women’s and Children’s Health, University of Liverpool, Liverpool, UK

Background: Delayed closure of ductus arteriosus in premature neonates is associated with significant morbidity. Rather than considering Patent Ductus Arteriosus (PDA) as being either present or not, it may be more appropriate to consider it as a disease spectrum ranging from biological normality to a pathological state associated with varying effects on organs. This study investigates this hypothesis by studying PDA characteristics simultaneously with biomarkers of cerebral function and anatomy.

Methods: An observational study to relate the size and haemodynamic effect of the PDA, (measured by echocardiographic biomarkers integrated into a PDA score) (1) with markers of cerebral pathophysiology: superior vena cava (SVC) flow, tissue oxygenation index (TOI), amplitude integrated electroencephalogram (aEEG score) (2) and severity of intraventricular haemorrhage (IVH). Inclusion criteria: babies between 24 and 28 weeks’ gestation, postnatal age <72 hours and PDA confirmed echocardiographically. The study was funded by the NEOCIRC FP7 fund. Local ethical approval and parental consent were obtained.

Results: Twenty-six babies were recruited: mean gestation age 26.9 weeks (SD 1.3), birth weight 0.94 Kg (SD 0.24). 10 had prolonged rupture of membranes, 17 received a full course of steroids and 18 were born via a spontaneous vaginal delivery. Larger PDA size was significantly associated with lower TOI (P=0.036) and higher severity of IVH (P=0.034). Patients with PDA size >2mm had lower cerebral TOI (69.3 vs. 61.1, P=0.024). Lower cerebral TOI was also significantly associated with higher severity of IVH (P=0.008). Higher PDA score was significantly associated with severe IVH (P=0.05) and approached significance for lower cerebral TOI (P=0.057). SVC flow did not correlate with any biomarker of cerebral or cardiac function. aEEG score was associated with markers of diastolic cardiac function (isovolumic relaxation time and EA wave ratio P=0.0031 and P=0.042 respectively) and approached statistical significance for cerebral TOI (P=0.084), but not severity of IVH (P=0.111).

Conclusion: Haemodynamically significant PDA is associated with reduced cerebral oxygenation and higher grade of IVH. SVC flow may not be a prognostic biomarker of cerebral perfusion. PDA score needs further validation as a biomarker of cerebral function.

Corresponding author: c.kotidis@liv.ac.uk

References
1. Sehgal, A.et al. Eur J Pediatr, 2013; 172(2): p. 179-84.
2 V.F. Burdjalov, Pediatrics, 2003; 112: p. 855–861.

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