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Comparative Study
. 2012 Jun;160(6):936-42.
doi: 10.1016/j.jpeds.2011.11.054. Epub 2012 Jan 9.

Cerebral autoregulation in neonates with a hemodynamically significant patent ductus arteriosus

Valerie Y Chock  1 , Chandra Ramamoorthy, Krisa P Van Meurs
Affiliations
Comparative Study

Cerebral autoregulation in neonates with a hemodynamically significant patent ductus arteriosus

Valerie Y Chock et al. J Pediatr. 2012 Jun.

Abstract

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.

Study design: 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.

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Figures

Figure 1
Figure 1. Changes in Cerebral Autoregulatory Capacity
(A) Simultaneous rSO2 and MAP tracing from a 26-week gestation infant during surgical ligation of a hsPDA. Despite fluctuations in MAP, rSO2 remains relatively stable, indicating intact cerebral autoregulation (r=−0.43). (B) The same preterm infant 2 hours after ligation demonstrates concordance between MAP and rSO2, indicating a loss of cerebral autoregulation (r=0.82).
Figure 2
Figure 2. Change in PPI after hsPDA Treatment
Average PPI is transiently increased following surgical ligation compared with conservative management (p=0.04) and decreased after indomethacin (p=0.0007). Differences in PPI become non-significant 6 hours after treatment in all groups.
See this image and copyright information in PMC

References

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