title: Cerebral oxygenation and echocardiographic parameters in preterm neonates with a patent ductus arteriosus: an observational study.
abstract: BACKGROUND
  A haemodynamically significant patent ductus arteriosus (hsPDA) is clinically suspected and confirmed by echocardiographic examination. A hsPDA decreases cerebral blood flow and oxygen saturation by the ductal steal phenomenon.
  
  
  OBJECTIVE
  To determine the relationship between echocardiographic parameters, cerebral oxygenation and a hsPDA in preterm infants.
  
  
  METHODS
  380 preterm infants (<32 weeks gestational age) born between 2008 and 2010 were included. Blinded echocardiographic examination was performed on the second, fourth and sixth day after birth. Examinations were deblinded when hsPDA was clinically suspected. Regional cerebral oxygen saturation (rScO2) was continuously monitored by near-infrared spectroscopy during 72 h after birth, and afterwards for at least 1 h before echocardiography. Echocardiographic parameters included ductal diameter, end-diastolic flow in the left pulmonary artery, left atrium/aorta ratio and ductal flow pattern.
  
  
  RESULTS
  rScO2was significantly related only to ductal diameter over time. Mixed modelling analysed the course of rScO2over time, where infants were divided into four groups: a closed duct, an open haemodynamically insignificant duct (non-sPDA), a hsPDA, which was successfully closed during study period (SC hsPDA) or a hsPDA, which was unsuccessfully closed during study period (UC hsPDA). SC hsPDA infants showed the highest rScO2on day 6, while UC hsPDA infants had the lowest rScO2values.
  
  
  CONCLUSIONS
  Ductal diameter is the only echocardiographic parameter significantly related to cerebral oxygenation over time. Cerebral oxygenation takes a different course over time depending on the status of the duct. Low cerebral oxygenation may be suggestive of a hsPDA.
authors.affiliation: Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands.
authors.forename: Laura
authors.initials: L
authors.lastname: Dix
authors.affiliation: Department of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands.
authors.forename: Mirella
authors.initials: M
authors.lastname: Molenschot
authors.affiliation: Department of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands.
authors.forename: Johannes
authors.initials: J
authors.lastname: Breur
authors.affiliation: Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: de Vries
authors.affiliation: Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands.
authors.forename: Daniel
authors.initials: D
authors.lastname: Vijlbrief
authors.affiliation: Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands.
authors.forename: Floris
authors.initials: F
authors.lastname: Groenendaal
authors.affiliation: Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: van Bel
authors.affiliation: Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands.
authors.forename: Petra
authors.initials: P
authors.lastname: Lemmers
keywords: cerebral oxygenation; echocardiography; near infrared spectroscopy; patent ductus arteriosus; preterm infants