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Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Cerebral hemodynamic changes in neonates with different types of patent ductus arteriosus: a study using transcranial
Jian-Feng Liu1, Zeng-Chun Wang2,3,4, Kai-Peng Sun1
1Department of Cardiac Surgery, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), Fujian Medical University, Fuzhou, China.
Objective:
This study aims to investigate the differences in cerebral hemodynamic parameters among neonates with patent ductus arteriosus (PDA) under varying hemodynamic conditions and to evaluate the cerebral hemodynamics in neonates with and without low cardiac output syndrome (LCOS) following PDA ligation.
Methods:
Neonates with PDA who were treated at our hospital between June 2021 and June 2024 were included in this study. The neonates were divided into two groups based on the presence of hemodynamically significant PDA (hsPDA): the hsPDA group and the non-hsPDA group. Additionally, they were categorized into the LCOS group and the non-LCOS group depending on whether LCOS developed within 48 h after PDA ligation. General clinical data, echocardiographic findings, and transcranial Doppler ultrasound data were collected and analyzed.
Results:
A total of 94 neonates with PDA were included in this study, including 41 with hsPDA and 53 without hsPDA. Compared with the non-hsPDA group, the hsPDA group had significantly lower anterior cerebral artery end-diastolic velocity (ACA-EDV) and mean velocity (ACA-MV), as well as higher resistance index (ACA-RI) (P < 0.001). The hsPDA group also had significantly lower diastolic blood pressure than the non-hsPDA group (P < 0.001). Among the 37 neonates who underwent PDA ligation, 14 developed postoperative LCOS and 23 did not. Compared with the non-LCOS group, neonates in the LCOS group showed significantly lower postoperative ACA-PSV, ACA-EDV, and ACA-MV, and higher ACA-RI (P < 0.001), whereas postoperative systolic and diastolic blood pressure did not differ significantly between the two groups.
Conclusion:
This study demonstrates significant differences in cerebral hemodynamic parameters among PDA neonates under various hemodynamic conditions. Transcranial Doppler ultrasound may provide valuable bedside information beyond systemic blood pressure for assessing cerebral perfusion in neonates with LCOS following PDA ligation.
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