Patent ductus arteriosus and cystic periventricular leucomalacia in preterm infants.
OBJECTIVE
To test the association between early disturbances in hemodynamics induced by left-to-right shunting through the duct and cystic periventricular leucomalacia.


METHODS
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.


RESULTS
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 279 ml kg-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.


CONCLUSIONS
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.
Pladys
P
P
Neonatal Intensive Care Unit, University Hospital, Rennes, France. patrick.pladys@universal.fr
Beuchée
A
A
Wodey
E
E
Tréguier
C
C
Lassel
L
L
Bétrémieux
P
P
D002543:Cerebral Hemorrhage / Q000209:etiology; D004374:Ductus Arteriosus, Patent / Q000150:complications* / Q000175:diagnosis; D004452:Echocardiography; D004453:Echoencephalography; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007969:Leukomalacia, Periventricular / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D012307:Risk Factors