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Updated: Dec 21, 2025
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Clinical validity of systemic arterial steal among extremely preterm infants with persistent patent ductus arteriosus
Lieke Keusters1, Jyotsna Purna1, Poorva Deshpande1,2
1Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada.
Insights
Abnormal diastolic flow in the middle cerebral artery (aMCA) is linked to adverse outcomes in preterm infants with persistent hemodynamically significant patent ductus arteriosus (phsPDA). Celiac trunk abnormalities (aCT) showed less relevance.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Medical Imaging
Background:
- Persistent hemodynamically significant patent ductus arteriosus (phsPDA) is common in preterm infants.
- Assessing phsPDA severity is crucial for clinical management and predicting outcomes.
- Diastolic flow abnormalities in specific arteries may indicate clinical significance.
Purpose of the Study:
- To investigate the relevance of diastolic flow abnormalities in the celiac trunk (aCT) and middle cerebral artery (aMCA) in preterm neonates with phsPDA.
- To determine if aCT or aMCA can serve as markers for phsPDA severity and associated morbidities.
Main Methods:
- Retrospective analysis of 515 echocardiograms from 156 preterm neonates (<28 weeks gestation).
- Comparison of infants with and without aCT or aMCA.
- Logistic regression analysis adjusted for confounders to assess the primary outcome (death, CLD, or NEC ≥ stage 2).
Main Results:
- Abnormalities in the middle cerebral artery (aMCA) were significantly associated with the primary composite outcome (adjusted OR 2.17) and chronic lung disease (CLD) (adjusted OR 2.20).
- Abnormalities in the celiac trunk (aCT) were not significantly associated with the primary outcome or CLD.
- Mean gestational age was 25.2 weeks and birth weight was 820g.
Conclusions:
- Abnormal middle cerebral artery (aMCA) diastolic flow may be a valuable marker for identifying clinically significant phsPDA in preterm infants.
- Celiac trunk abnormalities (aCT) appear to have limited value in selecting preterm neonates with phsPDA for treatment.
- Further research may refine the use of vascular flow patterns in managing phsPDA.
Objective:
Investigate relevance of diastolic flow abnormalities in celiac trunk (aCT) and middle cerebral artery (aMCA) among preterms with persistent hemodynamically significant patent ductus arteriosus (phsPDA, diameter ≥ 1.5 mm, and age ≥ 7 days).
Study Design:
Five hundred fifteen echocardiograms from 156 neonates born <28 weeks gestation age (GA) were analyzed retrospectively. Infants with aCT or aMCA at any time were compared with the rest. Separate comparisons were performed for aCT and aMCA. Primary outcome was composite of death, chronic lung disease (CLD), or necrotizing enterocolitis ≥ stage 2. Logistic regression was used to adjust for confounders.
Result:
Mean (SD) weight and GA were 820(214) g and 25.2(1.3) weeks. aMCA, but not aCT, was associated with primary outcome [adjusted odds ratio 2.17, 95% CI: 1.01-4.67] and CLD [2.20 (0.99-4.87)].
Conclusion:
aMCA may be a valid marker for defining the clinical significance of phsPDA in preterm neonates. aCeT may be of limited value in selecting patients for treatment.
