Delayed Surgical Closure of the Patent Ductus Arteriosus: Does the Brain Pay the Price? - 14/03/23

Doi : 10.1016/j.jpeds.2022.10.010

Petra Lemmers, MD, PhD, Daniel Vijlbrief, MD, PhD, Manon Benders, MD, PhD, Thomas Alderliesten, MD, PhD, Moniek Veldhuis, MD, Wim Baerts, MD, PhD, Corine Koopman-Esseboom, MD, PhD, Floris Groenendaal, MD, PhD, Frank van Bel, MD, PhD ^⁎
Department of Neonatology, Wilhelmina Children’s Hospital and Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands

^∗Reprint requests: Frank van Bel, MD, PhD, Department of Neonatology, University Medical Center, Utrecht/Wilhelmina Children’s Hospital, Room KE 04.123.1, P.O. Box 85090, 3508 AB Utrecht, The NetherlandsDepartment of NeonatologyUniversity Medical CenterUtrecht/Wilhelmina Children’s HospitalRoom KE 04.123.1P.O. Box 85090Utrecht3508 ABThe Netherlands

Abstract

Objective

To investigate the relation between duration of hemodynamically significant patent ductus arteriosus (PDA), cerebral oxygenation, magnetic resonance imaging–determined brain growth, and 2-year neurodevelopmental outcome in a cohort of infants born preterm whose duct was closed surgically.

Study design

Infants born preterm at <30 weeks of gestational age who underwent surgical ductal closure between 2008 and 2018 (n = 106) were included in this observational study. Near infrared spectroscopy–monitored cerebral oxygen saturation during and up to 24 hours after ductal closure and a Bayley III developmental test at the corrected age of 2 years is the institutional standard of care for this patient group. Infants also had magnetic resonance imaging at term-equivalent age.

Results

In total, 90 infants fulfilled the inclusion criteria (median [range]: 25.9 weeks [24.0-28.9]; 856 g [540-1350]. Days of a PDA ranged from 1 to 41. Multivariable linear regression analysis showed that duration of a PDA negatively influenced cerebellar growth and motor and cognitive outcome at 2 years of corrected age.

Conclusions

Prolonged duration of a PDA in this surgical cohort is associated with reduced cerebellar growth and suboptimal neurodevelopmental outcome.

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Abbreviations : Cer-vol, Cogn-score, hsPDA, MLR, Mot-score, MRI, NEC, NICU, PDA, PIVH, PLCS, PLDcort, rScO₂, SaO₂, SLR

Plan

Methods

Clinical Data and PDA Management

Monitoring of Cerebral Tissue Oxygenation and Perfusion

MRI Data Acquisition

Image Processing

Neurodevelopmental Assessment at 2 Years of Age

Physiological Data Collection and Analysis

The authors declare no conflict of interest.

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Vol 254

P. 25-32 - mars 2023 Retour au numéro

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Delayed Surgical Closure of the Patent Ductus Arteriosus: Does the Brain Pay the Price? - 14/03/23

Abstract

Objective

Study design

Results

Conclusions

Plan

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