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Patent ductus arteriosus and cystic periventricular leucomalacia in preterm infants
1Neonatal Intensive Care Unit, University Hospital, Rennes, France. patrick.pladys@universal.fr
Insights
Early hemodynamic changes in preterm infants with a significant patent ductus arteriosus (sPDA) are linked to increased risk of cystic periventricular leucomalacia. This association highlights potential early indicators for neonatal brain injury.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
Background:
- Cystic periventricular leucomalacia (PVL) is a major cause of neurological disability in preterm infants.
- Hemodynamic disturbances, particularly left-to-right shunting through the patent ductus arteriosus (PDA), are common in preterm neonates.
Purpose of the Study:
- To investigate the association between early hemodynamic alterations caused by PDA and the development of cystic PVL.
- To identify early markers of brain injury in high-risk preterm infants.
Main Methods:
- A cohort of 46 preterm infants (27-32 weeks gestation) at risk for PDA was studied.
- Significant PDA (sPDA) was defined by absent or reversed end-diastolic flow in the subductal aorta on days 1 and 4.
- Cerebral artery and subductal aortic resistance indices were measured.
Main Results:
- Infants who developed cystic PVL showed a higher incidence of sPDA on day 1 (64% vs. 26%).
- Higher left ventricular output and increased use of rescue surfactant were observed in the cystic PVL group.
- Increased resistance index in the anterior cerebral artery was associated with sPDA and correlated with subductal aortic resistance.
Conclusions:
- Early sPDA on day 1 is associated with altered cerebral blood flow velocity waveforms.
- The findings suggest a potential link between early hemodynamic changes from sPDA and the emergence of cystic PVL in preterm infants.
- While the association is noted, a causal relationship requires further investigation.
Aim:
To test the association between early disturbances in hemodynamics induced by left-to-right shunting through the duct and cystic periventricular leucomalacia.
Patients:
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.
Main Outcome:
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.
Conclusion:
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.