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Cerebral and aortic blood flow velocity patterns in preterm infants receiving prophylactic surfactant treatment
F van Bel1, P J de Winter, H B Wijnands
1Department of Pediatrics, University Hospital, Leiden, The Netherlands.
Insights
Surfactant treatment in premature infants temporarily affects cerebral blood flow, causing abnormal velocity and fluctuations. This treatment also increases the likelihood of left-to-right shunting in the infant
Area of Science:
- Neonatal Physiology
- Pediatric Cardiology
- Medical Ultrasound
Background:
- Premature infants often require respiratory support.
- Surfactant therapy is a standard treatment for respiratory distress syndrome in preterm neonates.
- Understanding the hemodynamic effects of surfactant is crucial for optimizing infant care.
Purpose of the Study:
- To investigate the impact of prophylactic surfactant administration on cerebral and aortic blood flow velocity in preterm infants.
- To assess cerebral perfusion and detect potential shunting following surfactant treatment.
- To compare hemodynamic parameters between surfactant-treated and control infants.
Main Methods:
- Duplex-Doppler ultrasound was used to measure blood velocity in the internal carotid artery (ICA) and descending thoracic aorta (DAo).
- Measurements were taken during and after surfactant instillation in 14 preterm infants (<30 weeks gestation).
- Eleven comparable control infants with mature lungs were included for comparison.
Main Results:
- Temporal mean blood velocity in the ICA (TMFV-cer) was reduced during surfactant instillation, indicating decreased cerebral flow.
- Cerebral blood velocity fluctuations (CV-cer) were elevated during surfactant administration.
- Pulsatility indices (PI-cer and PI-DAo) were high post-treatment, suggesting a left-to-right shunt.
- At 10 minutes post-surfactant, TMFV-cer increased in treated infants compared to controls, with stable CV-cer in both groups.
Conclusions:
- Surfactant administration transiently alters cerebral perfusion in preterm infants.
- Elevated pulsatility indices suggest a common occurrence of left-to-right shunting after surfactant treatment.
- These findings highlight the need for careful hemodynamic monitoring in neonates receiving surfactant therapy.
Abstract:
Blood velocity in the internal carotid artery (ICA) and in the descending thoracic aorta (DAo) was investigated used Duplex-Doppler ultrasound in 14 infants of less than 30 weeks gestation, treated prophylactically with surfactant, and in 11 comparable infants with relatively mature lungs who served as controls. After surfactant administration, blood gases, pH or FiO2 were not different between the groups. Temporal mean blood velocity in the ICA was used as a relative measure of cerebral flow (TMFV-cer), and its coefficient of variation (CV-cer) was used to assess fluctuations in cerebral blood velocity. The pulsatility index (PI) in the ICA (PI-cer) and DAo (PI-DAo) was used to estimate if a left-to-right shunt was present. During surfactant instillation TMFV-cer was abnormally low and CV-cer indicated a fluctuating cerebral blood velocity. At 10 min after surfactant administration, TMFV-cer of the treated infants was higher compared to the controls, while CV-cer was stable in both groups. PI-cer and PI-DAo were abnormally high during the first hour of life after surfactant treatment, suggesting a left-to-right shunt without, however, clinical signs of a hemodynamically important ductus arteriosus. We suggest that cerebral perfusion is affected during and at 10 min after surfactant instillation. Left-to-right shunting appears to be a common event following surfactant treatment.