Periventricular haemorrhage: association with patent ductus arteriosus and its treatment with indomethacin or surgery.
A prospective study on 150 infants with a birthweight of 1250 g or less was carried out to investigate the effects of patent ductus arteriosus (PDA), haemorrhagic pulmonary oedema (HPO), Indomethacin therapy and surgical ligation on the development of periventricular haemorrhage (PVH) or the extension of pre-existing PVH. The incidence of PVH, diagnosed by serial cerebral ultrasonography was 44% and the incidence of PDA, diagnosed by serial M-mode and contrast echocardiography, was 45%. During the first 8 days after birth when the infants were vulnerable to PVH, the development of PDA did not lead to the development or extension of PVH in 85% of infants. Haemorrhagic pulmonary oedema also had no effect on PVH in 71% of infants. Compared with infants whose PDA or HPO had no effect on PVH, those who had development or extension of haemorrhage had significantly more severe hypercapnia, blood gas instability and hypotension associated with the occurrence of PDA or HPO. Early Indomethacin therapy was not associated with the development or extension of PVH in 93% of infants. Although an elevation of arterial blood pressure was demonstrated after ductal ligation, surgery was performed after 1 week of age in all infants and in no instance was there an effect on PVH. This study suggests that PDA leads to PVH only if it causes significant blood gas and blood pressure disturbances which are known to affect cerebral blood flow adversely.
D002543:Cerebral Hemorrhage / Q000209:etiology*; D002552:Cerebral Ventricles; D004374:Ductus Arteriosus, Patent / Q000150:complications* / Q000628:therapy; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000209:etiology*; D008026:Ligation; D011654:Pulmonary Edema / Q000150:complications
D007213:Indomethacin