Brain and renal oxygenation measured by NIRS related to patent ductus arteriosus in preterm infants: a prospective observational study

Jurate Navikiene, Ernestas Virsilas, Ramune Vankeviciene, Arunas Liubsys, Augustina Jankauskiene, Jurate Navikiene, Ernestas Virsilas, Ramune Vankeviciene, Arunas Liubsys, Augustina Jankauskiene

Abstract

Background: Patent ductus arteriosus (PDA) is common among preterm neonates. Haemodynamically significant ductus arteriosus (hsPDA) can cause ductal steal and contribute to poor outcomes. Our aim was to evaluate ductus arteriosus patency and significance using two-site near-infrared spectroscopy (NIRS) measurements in preterm infants older than 72 h as a supplemental tool to echocardiography.

Methods: In this prospective observational study, 123 preterm infants (gestational age (GA) < 32 weeks, birth weight < 1500 g) were enrolled. Sixty-four newborns had closed ductus arteriosus (noPDA), and 41 and 18 patients were assigned to the PDA and hsPDA groups, respectively, per predefined echocardiographic criteria. Cerebral and renal oxygenation were assessed during NIRS monitoring.

Results: A higher renal mean (±SD) regional tissue oxygen saturation (rSpO2) (76.7 (±7.64)) was detected in the noPDA group than in the PDA (71.7 (±9.02)) and hsPDA (67.4 (±13.48)) groups (p < 0.001). Renal fractional tissue oxygen extraction (FTOE) (0.18 (±0.079)) was lower in the noPDA group than in the PDA (0.23 (±0.092)) and hsPDA (0.24 (±0.117))0.117 groups (p = 0.002). Cerebral oxygenation was significantly lower in the hsPDA group (77.0 (±5.16)) than in the noPDA (79.3 (±2.45)) and PDA (79.7 (±2.27)) groups (p = 0.004). There was no significant difference in cerebral fractional tissue oxygen extraction (FTOE) between any of the groups.

Conclusions: Our results suggest that renal oxygenation is affected by ductus patency in preterm infants older than 72 h. Significant differences in cerebral oxygenation were observed between the hsPDA group and the PDA and noPDA groups.

Trial registration: ClinicalTrials.gov Identifier: NCT04295395. Registration date: 4 March 2020. This study was retrospectively registered, https://ichgcp.net/clinical-trials-registry/NCT04295395 .

Keywords: Cerebral oxygenation; Near-infrared spectroscopy; Patent ductus arteriosus; Preterm infant; Renal oxygenation.

Conflict of interest statement

The authors declare that they have no conflicts of interest to disclose, financially or otherwise.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Consort diagram of the study

References

    1. Clyman RI, Couto J, Murphy GM. Patent ductus arteriosus: are current neonatal treatment options better or worse than no treatment at all? Semin Perinatol. 2012;36:123–129. doi: 10.1053/j.semperi.2011.09.022.
    1. Clyman RI. Mechanisms regulating the ductus arteriosus. Biol Neonate. 2006;89:330–335. doi: 10.1159/000092870.
    1. Dollberg S, Lusky A, Reichman B. Patent ductus arteriosus, indomethacin and necrotizing enterocolitis in very low birth weight infants: a population-based study. J Pediatr Gastroenterol Nutr. 2005;40:184–188. doi: 10.1097/00005176-200502000-00019.
    1. Evans N, Kluckow M. Early ductal shunting and intraventricular haemorrhage in ventilated preterm infants. Arch Dis Child Fetal Neonatal Ed. 1996;75:183–186. doi: 10.1136/fn.75.3.F183.
    1. Chorne N, Leonard C, Piecuch R, Clyman RI. Patent ductus arteriosus and its treatment as risk factors for neonatal and neurodevelopmental morbidity. Pediatrics. 2007;119:1165–1174. doi: 10.1542/peds.2006-3124.
    1. Velazquez DM, Reidy KJ, Sharma M, Kim M, Vega M, Havranek T. The effect of hemodynamically significant patent ductus arteriosus on acute kidney injury and systemic hypertension in extremely low gestational age newborns. J Matern Neonatal Med. 2019.
    1. Shepherd JL, Noori S. What is a hemodynamically significant PDA in preterm infants? Congenit Heart Dis. 2019.
    1. Pellicer A, del Bravo MC. Near-infrared spectroscopy: a methodology-focused review. Semin Fetal Neonatal Med. 2011;16:42–49. doi: 10.1016/j.siny.2010.05.003.
    1. McNeill S, Gatenby JC, McElroy S, Engelhardt B. Normal cerebral, renal and abdominal regional oxygen saturations using near-infrared spectroscopy in preterm infants. J Perinatol. 2011;31:51–57. doi: 10.1038/jp.2010.71.
    1. Kenosi M, Naulaers G, Ryan C, Dempsey E. Current research suggests that the future looks brighter for cerebral oxygenation monitoring in preterm infants. Acta Paediatr. 2015;104:225–231. doi: 10.1111/apa.12906.
    1. Chock VY, Rose LA, Mante JV, Punn R. Near-infrared spectroscopy for detection of a significant patent ductus arteriosus. Pediatr Res. 2016;80:675–680. doi: 10.1038/pr.2016.148.
    1. Underwood MA, Milstein JM, Sherman MP. Near-infrared spectroscopy as a screening tool for patent ductus arteriosus in extremely low birth weight infants. Neonatology. 2007;91:134–139. doi: 10.1159/000097131.
    1. van der Laan ME, Roofthooft MTR, Fries MWA, Berger RMF, Schat TE, van Zoonen AGJF, et al. A hemodynamically significant patent ductus arteriosus does not affect cerebral or renal tissue oxygenation in preterm infants. Neonatology. 2016;110:141–147. doi: 10.1159/000445101.
    1. Als H, Lawhon G, Duffy FH, McAnulty GB, Gibes-Grossman R, Blickman JG. Individualized developmental care for the very low-birth-weight preterm infant. Medical and neurofunctional effects. JAMA. 1994;272:853–858. doi: 10.1001/jama.1994.03520110033025.
    1. Wardle SP, Yoxall CW, Weindling AM. Determinants of cerebral fractional oxygen extraction using near infrared spectroscopy in preterm neonates. J Cereb Blood Flow Metab. 2000;20:272–279. doi: 10.1097/00004647-200002000-00008.
    1. Petrova A, Bhatt M, Mehta R. Regional tissue oxygenation in preterm born infants in association with echocardiographically significant patent ductus arteriosus. J Perinatol. 2011;31:460–464. doi: 10.1038/jp.2010.200.
    1. Kim ES, Kaiser JR, Rios DR, Bornemeier RA, Rhee CJ. Cerebral hemodynamics are not affected by the size of the patent ductus arteriosus. Neonatology. 2020;117:182–188. doi: 10.1159/000506835.
    1. Naulaers G, Morren G, Van Huffel S, Casaer P, Devlieger H. Cerebral tissue oxygenation index in very premature infants. Arch Dis Child Fetal Neonatal Ed. 2002;87:189–192. doi: 10.1136/fn.87.3.F189.
    1. Alderliesten T, Lemmers PMA, Smarius JJM, Van De Vosse RE, Baerts W, Van Bel F. Cerebral oxygenation, extraction, and autoregulation in very preterm infants who develop peri-intraventricular hemorrhage. J Pediatr. 2013;162.
    1. Tsuji M, Saul JP, Du Plessis A, Eichenwald E, Sobh J, Crocker R, et al. Cerebral intravascular oxygenation correlates with mean arterial pressure in critically ill premature infants. Pediatrics. 2000.
    1. Behrman RE, Martin CG, Snider AR, Katz SM, Peabody JL, Brady JP. Abnormal cerebral blood flow patterns in preterm infants with a large patent ductus arteriosus. J Pediatr. 1982;101:587–593. doi: 10.1016/S0022-3476(82)80715-4.
    1. Lemmers PMA, Toet M, Van Schelven LJ, Van Bel F. Cerebral oxygenation and cerebral oxygen extraction in the preterm infant: the impact of respiratory distress syndrome. Exp Brain Res. 2006;173:458–467. doi: 10.1007/s00221-006-0388-8.
    1. Schwarz CE, Preusche A, Wolf M, Poets CF, Franz AR. Prospective observational study on assessing the hemodynamic relevance of patent ductus arteriosus with frequency domain near-infrared spectroscopy. BMC Pediatr. 2018;18:1–7. doi: 10.1186/s12887-018-1054-6.
    1. Arman D, Sancak S, Gürsoy T, Topcuoğlu S, Karatekin G, Ovalı F. The association between NIRS and Doppler ultrasonography in preterm infants with patent ductus arteriosus. J Matern Neonatal Med. 2020;33:1245–1252. doi: 10.1080/14767058.2019.1639661.
    1. Poon WB, Tagamolila V. Cerebral perfusion and assessing hemodynamic significance for patent ductus arteriosus using near infrared red spectroscopy in very low birth weight infants. J Matern Neonatal Med. 2019;7058:1–6.
    1. Lemmers PMA, Toet MC, Van Bel F. Impact of patent ductus arteriosus and subsequent therapy with indomethacin on cerebral oxygenation in preterm infants. Pediatrics. 2008.
    1. Okur N, Tayman C, Büyüktiryaki M, Kadıoğlu Şimşek G, Ozer Bekmez B, Altuğ N. Can lactate levels be used as a marker of patent ductus arteriosus in preterm babies? J Clin Lab Anal. 2019;33:1–5. doi: 10.1002/jcla.22664.
    1. Simon SR, Van Zogchel L, Bas-Suárez MP, Cavallaro G, Clyman RI, Villamor E. Platelet counts and patent ductus arteriosus in preterm infants: a systematic review and Meta-analysis. Neonatology. 2015;108:143–151. doi: 10.1159/000431281.
    1. Noori S. Patent ductus arteriosus in the preterm infant: to treat or not to treat? J Perinatol. 2010;30(SUPPL. 1):31–37. doi: 10.1038/jp.2010.97.
    1. Brooks JM, Travadi JM, Patole SK, Doherty DA, Simmer K. Is surgical ligation of patent ductus arteriosus necessary? The Western Australian experience of conservative management. Arch Dis Child Fetal Neonatal Ed. 2005;90:235–239. doi: 10.1136/adc.2004.057638.
    1. Abu-Shaweesh JM, Almidani E. PDA: does it matter? Int J Pediatr Adolesc Med. 2020;7:9–12. doi: 10.1016/j.ijpam.2019.12.001.
    1. Nemri AMH Al Patent ductus arteriosus in preterm infant: basic pathology and when to treat. Sudan J Paediatr. 2014;14:25–30.
    1. Prescott S, Keim-Malpass J. Patent ductus arteriosus in the preterm infant: diagnostic and treatment options. Adv Neonatal Care. 2017;17:10–18. doi: 10.1097/ANC.0000000000000340.

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