title: Cerebral oxygenation during different treatment strategies for a patent ductus arteriosus.
abstract: BACKGROUND
  Preterm infants with a hemodynamically significant patent ductus arteriosus (hsPDA) are at risk for fluctuations in cerebral blood flow, but it is unclear how different hsPDA treatment strategies may affect cerebral oxygenation.
  
  
  OBJECTIVE
  To compare regional cerebral oxygen saturation (rSO(2)) as measured by near-infrared spectroscopy (NIRS) in very low birth weight (VLBW) infants with a hsPDA treated with conservative management, indomethacin, or surgical ligation.
  
  
  METHODS
  This prospective observational study enrolled 33 VLBW infants with a hsPDA diagnosed by echocardiogram and 12 control VLBW infants without a hsPDA. Infants had NIRS cerebral monitoring applied prior to conservative treatment, indomethacin, or surgical ligation. Cranial ultrasound and magnetic resonance imaging data were also collected.
  
  
  RESULTS
  Infants undergoing surgical ligation had a greater time period with >20% change in rSO(2) from baseline (30%) compared to those receiving indomethacin (7.4%, p = 0.001) or control infants without a hsPDA (2.6%, p = 0.0004). NIRS measures were not associated with abnormal neuroimaging in this small cohort.
  
  
  CONCLUSIONS
  These findings suggest that infants requiring surgical ligation for a hsPDA are at high risk for significant changes in cerebral oxygenation, whereas those receiving either indomethacin or conservative management maintain relatively stable cerebral oxygenation levels. Additional research is necessary to determine if NIRS monitoring identifies infants with a hsPDA at highest risk for brain injury.
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA 94304, USA. vchock@stanford.edu
authors.forename: Valerie Y
authors.initials: VY
authors.lastname: Chock
authors.forename: Chandra
authors.initials: C
authors.lastname: Ramamoorthy
authors.forename: Krisa P
authors.initials: KP
authors.lastname: Van Meurs
mesh_terms: D001921:Brain / Q000098:blood supply; D002560:Cerebrovascular Circulation / Q000502:physiology*; D004373:Ductus Arteriosus / Q000601:surgery; D004374:Ductus Arteriosus, Patent / Q000097:blood* / Q000000981:diagnostic imaging / Q000628:therapy*; D004452:Echocardiography; D005260:Female; D005865:Gestational Age; D006439:Hemodynamics; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000378:metabolism*; D008026:Ligation; D008297:Male; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology*; D019265:Spectroscopy, Near-Infrared / Q000379:methods
chemical_list: D010100:Oxygen; D007213:Indomethacin