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.

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Repeatability of echocardiographic parameters to evaluate the hemodynamic relevance of patent ductus arteriosus in preterm infants: a prospective observational study

BMC Pediatrics ◽

10.1186/s12887-016-0552-7 ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 13

Author(s):

Christoph E. Schwarz ◽

Antonio Preusche ◽

Winfried Baden ◽

Christian F. Poets ◽

Axel R. Franz

Keyword(s):

Observational Study ◽

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Prospective Observational Study ◽

Ductus Arteriosus ◽

Echocardiographic Parameters ◽

Patent Ductus

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Effect of Fentanyl Boluses on Cerebral Oxygenation and Hemodynamics in Preterm Infants: A Prospective Observational Study

Neonatology ◽

10.1159/000508555 ◽

2020 ◽

Vol 117 (4) ◽

pp. 480-487

Author(s):

Souvik Mitra ◽

M. Ege Babadagli ◽

Tara Hatfield ◽

Averie dePalma ◽

Helen McCord ◽

...

Keyword(s):

Cardiac Output ◽

Observational Study ◽

Preterm Infants ◽

Prospective Observational Study ◽

Cerebral Oxygenation ◽

Left Ventricular ◽

Oxygen Extraction ◽

Preterm Neonates ◽

Tissue Oxygen ◽

Significant Difference

Background: Fentanyl is a commonly used off-label medication for pain control and sedation in preterm infants. Yet, the effect of fentanyl on cerebral hemodynamics in preterm neonates remains unexplored. Objective: To evaluate the effect of a bolus dose of fentanyl on the regional cerebral oxygen saturation (RcSO2), cerebral fractional tissue oxygen extraction (cFTOE) and left ventricular output (LVO) as compared with pre-administration baseline in preterm infants. Methods: This was a prospective observational study conducted in a level III Canadian NICU from September 2017 to February 2019. Preterm infants born <37 weeks of gestation and scheduled to receive a fentanyl bolus (1–2 μg/kg/dose) were eligible. Infants with major congenital anomalies, medically unstable and those who had received fentanyl in the previous 48 h were excluded. Outcomes: The primary outcome was the difference between RcSO2 measured 5 min prior to and RcSO2 measured at defined time points after administration of fentanyl. Results: Twenty-eight infants were enrolled during the study period (median gestational age 28 weeks; interquartile range [IQR] 25–29 weeks; median birth weight 1,035 g [IQR 830–1,292 g]; median age 4 days [IQR 3–7 days]). Mean (±standard deviation) baseline RcSO2 was 73.6% (±11.8), cFTOE was 21.9 (±11.2) and LVO was 380 (±147) mL/kg/min prior to fentanyl infusion. One-way ANOVA showed no statistically significant difference between baseline and any of the post-fentanyl cerebral oxygenation, tissue oxygen extraction or cardiac output measures (p > 0.05). Conclusion: Administration of fentanyl bolus for procedural pain and sedation was not shown to significantly affect cerebral oxygenation, cerebral tissue oxygen extraction or cardiac output in stable preterm infants.

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Lung function in very preterm infants with patent ductus arteriosus under conservative management: an observational study

BMC Pediatrics ◽

10.1186/s12887-015-0480-y ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 9

Author(s):

Hsiu-Lin Chen ◽

Rei-Cheng Yang ◽

Wei-Te Lee ◽

Pei-Lun Lee ◽

Jong-Hau Hsu ◽

...

Keyword(s):

Lung Function ◽

Observational Study ◽

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Conservative Management ◽

Ductus Arteriosus ◽

Very Preterm Infants ◽

Very Preterm ◽

Patent Ductus

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Prospective observational study on assessing the hemodynamic relevance of patent ductus arteriosus with frequency domain near-infrared spectroscopy

BMC Pediatrics ◽

10.1186/s12887-018-1054-6 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 9

Author(s):

Christoph E. Schwarz ◽

Antonio Preusche ◽

Martin Wolf ◽

Christian F. Poets ◽

Axel R. Franz

Keyword(s):

Infrared Spectroscopy ◽

Observational Study ◽

Patent Ductus Arteriosus ◽

Frequency Domain ◽

Near Infrared Spectroscopy ◽

Prospective Observational Study ◽

Near Infrared ◽

Ductus Arteriosus ◽

Patent Ductus

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“Shunt index” can be used to predict clinically significant patent ductus arteriosus in premature neonates in early post-natal life

Cardiology in the Young ◽

10.1017/s1047951113000772 ◽

2013 ◽

Vol 24 (4) ◽

pp. 605-609 ◽

Cited By ~ 1

Author(s):

Ece Yapakçı ◽

Ayşe Ecevit ◽

Birgin Törer ◽

Deniz Anuk Ince ◽

Mahmut Gökdemir ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Oxygen Saturation ◽

Preterm Infants ◽

Ductus Arteriosus ◽

Venous Blood ◽

Blood Gases ◽

Oxygen Extraction ◽

Caval Vein ◽

Inferior Caval Vein ◽

Patent Ductus

AbstractBackground: This study aimed to examine the differences between arterial and inferior caval vein oxygen saturation, fractional oxygen extraction, and the shunt index, which were calculated in the diagnosis of patent ductus arteriosus. Methods: Twenty-seven preterm infants were included in this study and were divided into two groups according to patent ductus arteriosus. Among them, 11 (41%) infants had haemodynamically significant patent ductus arteriosus and 16 (59%) did not have significant patent ductus arteriosus. Synchronous arterial and venous blood gases were measured during the first post-natal hours after the insertion of umbilical catheters. The differences between arterial and inferior caval vein oxygen saturation, inferior body fractional oxygen extraction, and the shunt index were calculated. Echocardiography was performed before the 72nd hour of life in a selected group of patients who had haemodynamically significant patent ductus arteriosus. Ibuprofen treatment was administered to patients with patent ductus arteriosus. Echocardiography was performed on the 72nd hour of life in preterm infants without any clinical suspicion of patent ductus arteriosus. Results: The early measured differences between arterial and inferior caval vein oxygen saturation and inferior body fractional oxygen extraction were found to be lower and the shunt index was found to be higher in the haemodynamically significant patent ductus arteriosus group than in the group without haemodynamically significant patent ductus arteriosus. Conclusion: We found that the shunt index, calculated in the first hours of life as ≥63%, predicted haemodynamically significant patent ductus arteriosus with a sensitivity of 78% and specificity of 82% in preterm newborns.

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