Cerebral perfusion and assessing hemodynamic significance for patent ductus arteriosus using near infrared red spectroscopy in very low birth weight infants

Abstract

Introduction/objective

To study the impact of hemodynamically significant patent ductus arteriosus (hsPDA), using near infrared red spectroscopy (NIRS) regional cerebral (SrO₂), renal (RrO₂) saturation measurements, and fractional tissue oxygenation extraction (FTOE) before and after medical and/or surgical treatment.

Methods

Prospective cohort study of very low birth weight (VLBW) preterm infants with hsPDA requiring treatment from March 2014 to December 2016 in a tertiary Neonatal Intensive Care Unit in Singapore. NIRS was applied at diagnosis until 24–48 h after the last dose of ibuprofen or postsurgical ligation. All PDAs were documented to be closed by echocardiography. Post-treatment values (control group) were compared against pretreatment values.

Results

Twenty-nine infants were studied, with mean gestational age of 26.7 weeks and birth weight of 956 g. Median day of life of PDA diagnosis was 4. Seven infants (24.1%) underwent PDA ligation. There was significant reduction in FTOE before treatment till after last dose of medication or ligation by a mean difference of 7.27% (p < .05). Reduction in FTOE was also found between the first dose of medication till after the last dose or ligation. Cerebral SrO₂ significantly increased between first dose of medication till last dose of medication by a mean difference of 3.09% (p = .034). RrSO2 values were not significantly affected. No correlation between NIRS values and PDA size was found.

Conclusions

Significant increase in cerebral SrO₂ and reduction in FTOE by NIRS post PDA closure in hemodynamically significant PDAs suggest that PDA closure may reduce cerebral hypoxia burden.

Keywords:

• Cerebral
• infants
• patent ductus arteriosus

Disclosure statement

The near infrared red spectroscopy (NIRS) machine and disposable probes were sponsored by Medtronic (Covidien) Pte Ltd., but the trial is an investigator initiated trial (IIT) with all stages planned and performed by the investigators and data controlled by the investigation team.