Abnormal Cerebral Hemodynamics in Preterm Infants with Patent Ductus Arteriosus

Abstract

Blood flow patterns in the anterior cerebral arteries were studied in eight preterm infants with patent ductus arteriosus and left-to-right shunts. A noninvasive Doppler technique was used to obtain the blood flow patterns and to calculate a pulsatility index. Advancing diastolic blood flow was decreased in all eight infants, and two demonstrated retrograde anterior cerebral artery flow during diastole. Following ductal closure, the diastolic flow in the anterior cerebral arteries increased significantly, reaching levels seen in normal infants. These observations demonstrate that infants with patent ductus arteriosus and left-to-right shunts may have abnormal cerebral hemodynamics which return to normal following ductal closure.

Association of Placebo, Indomethacin, Ibuprofen, and Acetaminophen With Closure of Hemodynamically Significant Patent Ductus Arteriosus in Preterm Infants

“…The utility of active management and the timing and modality of PDA treatment have been debated . Persistent ductal shunting may lead to pulmonary overcirculation, increasing the risk of bronchopulmonary dysplasia; conversely, shunting may induce systemic hypoperfusion, increasing the risk of necrotizing enterocolitis, intraventricular hemorrhage, renal failure, and death . Nonsteroidal anti-inflammatory drugs along with other pharmacotherapeutic agents have been used to close PDAs to prevent such complications.…”

Management strategies for the preemie ductus

“…Left-to-right shunting through the PDA can lead to pulmonary edema, inefficient gas exchange, and elevated left ventricular (LV) end-diastolic volume. This pulmonary over-circulation and systemic under-perfusion has been implicated in increased risk of necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), acute kidney injury, and death [12][13][14]. The mechanism however is not entirely clear.…”

Comparative safety and efficacy of paracetamol versus non‐steroidal anti‐inflammatory agents in neonates with patent ductus arteriosus: A systematic review and meta‐analysis of randomized controlled trials

“…Gestational age (GA) is inversely correlated with time to ductus closure, remaining patent in the seventh postnatal day in 2%, 65% and 87% of neonates born at 30–37 weeks GA, 25–28 weeks GA and 24th week GA, respectively 2 . Patent ductus arteriosus (PDA) constitutes a common cardiovascular problem of prematurity that may lead to pulmonary overcirculation, respiratory distress and increased risk of bronchopulmonary dysplasia (BPD) 3,4 …”

“…2 Patent ductus arteriosus (PDA) constitutes a common cardiovascular problem of prematurity that may lead to pulmonary overcirculation, respiratory distress and increased risk of bronchopulmonary dysplasia (BPD). 3,4 Non-steroidal anti-inflammatory drugs (NSAIDs) ibuprofen and indomethacin have been used as pharmacological treatment for PDA closure. 5 These agents act on the cyclo-oxygenase cycle, inducing peripheral vasoconstriction among other actions.…”