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

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://clinicaltrials.gov/ct2/show/NCT04295395.

Renal Oxygen Saturations and Acute Kidney Injury in the Preterm Infant with Patent Ductus Arteriosus

“…The optimal period of monitoring of Rsat for AKI prediction may be earlier than the time the echocardiogram was obtained; for example, a prior study found that low Rsat during the first day of life was associated with the development of AKI on day 2 to day 7. 2 Although we expected lower renal saturations in the hsPDA group, as demonstrated previously, 8,22 there have been differing results in other studies, which have shown no correlation between Rsat and hsPDA. 23 This may reflect the variability among patient populations.…”

“…Although we expected lower renal saturations in the hsPDA group, as demonstrated previously [8,22], there have been differing results in other studies, which have shown no correlation between Rsat and hsPDA [23]. This may reflect the variability among patient populations.…”

Renal Saturations and Acute Kidney Injury in the Preterm Infant with Patent Ductus Arteriosus

“…Our study found a 42% incidence of AKI in those with hsPDA, which is higher than the reported incidence of 34% 3 . Although we hypothesized lower renal saturations in the hsPDA group, as demonstrated previously 8, 23 , there have been studies that have shown no correlation between Rsat and hsPDA 24 . This may re ect the variability among patient populations.…”

Impact of Medical Treatment of Hemodynamically Significant Patent Ductus Arteriosus on Cerebral and Renal Tissue Oxygenation Measured by Near-Infrared Spectroscopy in Very Low-Birth-Weight Infants

“…Some clinical studies demonstrated a faster and marked deterioration of renal oxygenation and blood flow in the presence of hsPDA, comparing with no effect or less apparent effect on brain oxygenation and perfusion [35,36]; therefore, it is likely that medical treatment-related closure or constriction of PDA primarily improves renal oxygenation and blood circulation. Moreover, the ductal shunt occurs predominantly from the lower rather than the upper body circulation [37].…”