Cerebral autoregulation in neonates with a hemodynamically significant patent ductus arteriosus.
OBJECTIVE
Very low birth weight (VLBW) preterm infants are at risk for impaired cerebral autoregulation with pressure passive blood flow. Fluctuations in cerebral perfusion may occur in infants with a hemodynamically significant patent ductus arteriosus (hsPDA), especially during ductal closure. Our goal was to compare cerebral autoregulation using near-infrared spectroscopy in VLBW infants treated for an hsPDA.


METHODS
This prospective observational study enrolled 28 VLBW infants with an hsPDA diagnosed by echocardiography and 12 control VLBW infants without an hsPDA. Near-infrared spectroscopy cerebral monitoring was applied during conservative treatment, indomethacin treatment, or surgical ligation. A cerebral pressure passivity index (PPI) was calculated, and PPI differences were compared using a mixed-effects regression model. Cranial ultrasound and magnetic resonance imaging data were also assessed.


RESULTS
Infants with surgically ligated hsPDAs were more likely to have had a greater PPI within 2 hours following ligation than were those treated with conservative management (P=.04) or indomethacin (P=.0007). These differences resolved by 6 hours after treatment.


CONCLUSIONS
Cerebral autoregulation was better preserved after indomethacin treatment of an hsPDA compared with surgical ligation. Infants requiring surgical hsPDA ligation may be at increased risk for cerebral pressure passivity in the 6 hours following surgery.
Stanford University School of Medicine, Palo Alto, CA, USA. vchock@stanford.edu
Valerie Y
VY
Chock
Chandra
C
Ramamoorthy
Krisa P
KP
Van Meurs
D001921:Brain / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D004374:Ductus Arteriosus, Patent / Q000175:diagnosis / Q000503:physiopathology*; D005500:Follow-Up Studies; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000502:physiology*; D008279:Magnetic Resonance Imaging; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared; D013997:Time Factors; D017585:Ultrasonography, Doppler, Transcranial