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Patent Ductus Arteriosus and Brain Volume
Petra M A Lemmers1, Manon J N L Benders2, Rita D'Ascenzo3
1Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Netherlands; p.lemmers@umcutrecht.nl.
Insights
Low cerebral oxygenation from patent ductus arteriosus (PDA) in preterm infants is linked to reduced brain volume. This suggests PDA impacts brain growth and neurodevelopmental outcomes.
Area of Science:
- Neonatal neuroscience
- Perinatal medicine
- Developmental neurology
Background:
- Hemodynamically significant patent ductus arteriosus (PDA) can impair cerebral perfusion and oxygenation in preterm infants.
- PDA is associated with increased mortality and morbidity in neonates.
- Long-standing low cerebral oxygenation due to PDA may affect brain volume at term-equivalent age.
Purpose of the Study:
- To investigate the relationship between cerebral oxygen saturation and regional brain volume.
- To assess the impact of PDA on brain growth and maturation at term-equivalent age.
Main Methods:
- Observational study of 140 preterm infants.
- Utilized near-infrared spectroscopy (NIRS) to monitor cerebral oxygen saturation (rSco2).
- Assessed regional brain volume and internal capsule maturation using MRI at term-equivalent age.
Main Results:
- Infants requiring surgical PDA closure exhibited the lowest rSco2 values and highest postnatal age before treatment.
- The surgery group showed reduced brain volumes at term-equivalent age compared to indomethacin-treated and control groups.
- Lower preductal rSco2 significantly correlated with reduced cerebellar volume in the surgery group.
Conclusions:
- Prolonged suboptimal cerebral oxygenation due to PDA may adversely affect brain development.
- These findings highlight the potential impact of PDA on neurodevelopmental outcomes.
- Early and effective closure of PDA is crucial for optimizing brain growth in preterm infants.
Background And Objectives:
A hemodynamically significant patent ductus arteriosus (PDA) can compromise perfusion and oxygenation of the preterm brain. Reports suggest that PDA is associated with increased mortality and morbidity. We hypothesize that long-standing low cerebral oxygenation due to PDA might affect brain volume at term equivalent age.
Methods:
Observational study in 140 infants investigating the relationship between near-infrared spectroscopy-monitored cerebral oxygen saturation (rSco2) and MRI-assessed regional brain volume and maturation of the posterior limb of the internal capsule at term-equivalent age in 3 groups: those whose PDA closed with indomethacin, those who needed additional surgical closure, and matched controls.
Results:
The surgery group had the lowest rSco2 values before closure (n = 35), 48% ± 9.7% (mean ± SD) as compared with the indomethacin (n = 35), 59% ± 10.4 (P < .001), and control groups (n = 70), 66% ± 6.9 (P < .001); the highest postnatal age before effective treatment; and the lowest volumes of most brain regions at term-equivalent age. Multiple linear regression analysis showed a significant effect of preductal closure rSco2 on cerebellar volume in this group. No differences were found in maturation of the posterior limb of the internal capsule.
Conclusions:
Long-standing suboptimal cerebral oxygenation due to a PDA may negatively influence brain growth, affecting neurodevelopmental outcome.
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