Effects of Patent Ductus Arteriosus on Organ Blood Flow in Infants Born Very Preterm: A Prospective Study with Serial Echocardiography

Kai-Hsiang Hsu; Jimmy Nguyen; Stephanie Dekom; Rangasamy Ramanathan; Shahab Noori

doi:10.1016/j.jpeds.2019.08.057

Effects of Patent Ductus Arteriosus on Organ Blood Flow in Infants Born Very Preterm: A Prospective Study with Serial Echocardiography

J Pediatr. 2020 Jan:216:95-100.e2. doi: 10.1016/j.jpeds.2019.08.057. Epub 2019 Oct 11.

Authors

Kai-Hsiang Hsu¹, Jimmy Nguyen², Stephanie Dekom³, Rangasamy Ramanathan³, Shahab Noori⁴

Affiliations

¹ Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA; Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan.
² Division of Neonatology, Cedar-Sinai Medical Center, Los Angeles, CA; Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA.
³ Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA.
⁴ Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA. Electronic address: snoori@chla.usc.edu.

PMID: 31610928
DOI: 10.1016/j.jpeds.2019.08.057

Abstract

Objective: To characterize the effects of a patent ductus arteriosus (PDA) on different organ blood flows in infants born preterm.

Study design: Infants born preterm at ≤30 weeks of gestational age had daily echocardiography and Doppler assessments of middle cerebral artery, celiac artery, superior mesenteric (SMA), and renal arteries (RA) during the first postnatal week. Abnormal organ blood flow was defined as either reverse or absent diastolic flow, abnormally low mean or systolic velocities, or abnormally high pulsatility or resistance index.

Results: Twenty-five infants born very preterm (gestational age 27.0 ± 2.1 weeks) were enrolled. PDA presence at time of measurement increased the risk of abnormal organ blood flows (39% vs 8%, P < .001). Ductal diameter and left atrium-to-aortic root (LA/Ao) ratio correlated positively with resistance index (celiac artery, SMA, RA), and negatively with mean velocity (ductal diameter: SMA, RA; LA/Ao ratio: RA). A PDA >2.0 mm, LA/Ao ratio >1.4, and their combination were associated with 8.0 (95% CI 1.6-39.4)-, 6.7 (1.3-34.7)-, and 38.2 (3.2-455.5)-fold increase in risk of abnormal organ blood flow index, respectively. Abnormal descending aorta flow was detected in only 2% of measurements.

Conclusions: Ductal size >2.0 mm and LA/Ao >1.4, especially in combination, are associated with a greater risk of abnormal organ blood flows. We suggest that Doppler assessment of the renal and superior mesenteric arteries are more likely to detect systemic hypoperfusion than the descending aorta.

Keywords: hemodynamic significance; hypoperfusion.

MeSH terms

Blood Flow Velocity*
Cardiac Output*
Ductus Arteriosus, Patent / complications
Ductus Arteriosus, Patent / physiopathology*
Echocardiography
Female
Gestational Age
Humans
Infant, Extremely Premature
Infant, Newborn
Male
Prospective Studies