Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Pediatrics
Published in: BMC Pediatrics 1/2018

Open Access 01-12-2018 | Research article

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

Authors: Christoph E. Schwarz, Antonio Preusche, Martin Wolf, Christian F. Poets, Axel R. Franz

Published in: BMC Pediatrics | Issue 1/2018

Login to get access

Abstract

Background

What constitutes a hemodynamically relevant patent ductus arteriosus (hrPDA) in preterm infants is unclear. Different clinical and echocardiographic parameters are used, but a gold standard definition is lacking.
Our objective was to evaluate associations between regional cerebral tissue oxygen saturation (rcStO2), fraction of tissue oxygen extraction (rcFtO2E) measured by frequency domain near-infrared spectroscopy (fd-NIRS) and their correlation to echocardiographic, Doppler-ultrasound, and clinical parameters in preterm infants with and without a hrPDA.

Methods

In this prospective observational study, 22 infants < 1500 g (mean [± SD]: gestational age 28.6 [±1.8] weeks, birth weight 1076 [±284] g, median (interquartile range) postnatal age at measurement 7.6 (4.6–12.9) d) with a clinical suspicion of hrPDA were analysed.
Twelve infants had left-to-right shunt through PDA, and in 6 of these the PDA was classified as hrPDA based on pre-defined clinical and echocardiographic criteria. fd-NIRS, echocardiographic and Doppler-ultrasound examinations were performed. After identification of blood hemoglobin (Hb) as confounding factor, rcStO2 and rcFtO2E were corrected for this effect.

Results

Overall mean ± standard deviation (normalised to a median Hb of 13.8 mg/dl) was 57 ±5% for rcStO2 and 0.39 ±0.05 for rcFtO2E. Comparing no-hrPDA with hrPDA infants, there were no significant differences in mean rcStO2 (58 ±5% vs. 54 ±5%; p = .102), but in mean rcFtO2E (0.38 ±0.05 vs. 0.43 ±0.05; p = .038). Echocardiographic parameter and Doppler indices did not correlate with cerebral oxygenation.

Conclusion

Oxygen transport capacity of the blood may confound NIRS data interpretation. Cerebral oxygenation determined by fd-NIRS provided additional information for PDA treatment decisions not offered by routine investigations. Whether indicating PDA therapy based on echocardiography complemented by data on cerebral oxygenation results in better outcomes should be investigated in future studies.
Literature
1.
Rozé JCCG, Marchand-Martin L, Gournay V, Durrmeyer X, Durox M, Storme L, Porcher R, Ancel PY, Hemodynamic EPIPAGE 2 Study Group. Association between early screening for patent ductus arteriosus and in-hospital mortality among extremely preterm infants. JAMA. 2015;313(24):2441–8.CrossRefPubMed
2.
Zonnenberg I, de Waal K. The definition of a haemodynamic significant duct in randomized controlled trials: a systematic literature review. Acta Paediatr. 2012;101(3):247–51.CrossRefPubMed
3.
McNamara PJ, Sehgal A. Towards rational management of the patent ductus arteriosus: the need for disease staging. Arch Dis Child Fetal Neonatal Edition. 2007;92(6):F424–7.CrossRefPubMed
4.
Schena FFG, Cappelleri A, Picciolli I, Mayer A, Mosca F, Fumagalli M. Association between hemodynamically significant patent ductus arteriosus and bronchopulmonary dysplasia. J Pediatr. 2015;166(6):1488–92.CrossRefPubMed
5.
Ecury-Goossen GM, Raets MM, Camfferman FA, Vos RH, van Rosmalen J, Reiss IK, Govaert P, Dudink J. Resistive indices of cerebral arteries in very preterm infants: values throughout stay in the neonatal intensive care unit and impact of patent ductus arteriosus. Pediatr Radiol. 2016;46(9):1291–300.CrossRefPubMedPubMedCentral
6.
Dix L, Molenschot M, Breur J, de Vries W, Vijlbrief D, Groenendaal F, van Bel F, Lemmers P. Cerebral oxygenation and echocardiographic parameters in preterm neonates with a patent ductus arteriosus: an observational study. Arch Dis Child Fetal Neonatal Ed. 2016;101:F520–6.CrossRef
7.
Chock VY, Rose LA, Mante JV, Punn R. Near-infrared spectroscopy for detection of a significant patent ductus arteriosus. Pediatr Res. 2016;80(5):675–80.CrossRefPubMed
8.
van der Laan ME, Roofthooft MT, Fries MW, Berger RM, Schat TE, van Zoonen AG, Tanis JC, Bos AF, Kooi EM. A hemodynamically significant patent ductus arteriosus does not affect cerebral or renal tissue oxygenation in preterm infants. Neonatology. 2016;110(2):141–7.CrossRefPubMed
9.
Demel A, Feilke K, Schoning M, Wolf M, Poets CF, Franz AR. Healthy term and moderately preterm infants have similar cerebral oxygen saturation and cerebral blood flow volumes during early post-natal transition. Acta Paediatr. 2015;104(8):e330–6.CrossRefPubMed
10.
Demel A, Wolf M, Poets CF, Franz AR. Effect of different assumptions for brain water content on absolute measures of cerebral oxygenation determined by frequency-domain near-infrared spectroscopy in preterm infants: an observational study. BMC Pediatr. 2014;14:206.CrossRefPubMedPubMedCentral
11.
Arri SJ, Muehlemann T, Biallas M, Bucher HU, Wolf M. Precision of cerebral oxygenation and hemoglobin concentration measurements in neonates measured by near-infrared spectroscopy. J Biomed Opt. 2011;16(4):047005.CrossRefPubMed
12.
Sorensen LC, Greisen G. Precision of measurement of cerebral tissue oxygenation index using near-infrared spectroscopy in preterm neonates. J Biomed Opt. 2006;11(5):054005.CrossRefPubMed
13.
Hyttel-Sorensen S, Hessel TW, Greisen G. Peripheral tissue oximetry: comparing three commercial near-infrared spectroscopy oximeters on the forearm. J Clin Monit Comput. 2014;28(2):149–55.CrossRefPubMed
14.
Green TP, Thompson TR, Johnson DE, Lock JE. Furosemide promotes patent ductus arteriosus in premature infants with the respiratory-distress syndrome. N Engl J Med. 1983;308(13):743–8.CrossRefPubMed
15.
Kluckow M, Evans N. Early echocardiographic prediction of symptomatic patent ductus arteriosus in preterm infants undergoing mechanical ventilation. J Pediatr. 1995;127(5):774–9.CrossRefPubMed
16.
Robel-Tillig E, Knupfer M, Pulzer F, Vogtmann C. Dopplersonographic findings in neonates with significant persistent ductus arteriosus. Z Geburtshilfe Neonatol. 2002;206(2):51–6.CrossRefPubMed
17.
Shimada S, Kasai T, Konishi M, Fujiwara T. Effects of patent ductus arteriosus on left ventricular output and organ blood flows in preterm infants with respiratory distress syndrome treated with surfactant. J Pediatr. 1994;125(2):270–7.CrossRefPubMed
18.
Martin CG, Snider AR, Katz SM, Peabody JL, Brady JP. Abnormal cerebral blood flow patterns in preterm infants with a large patent ductus arteriosus. J Pediatr. 1982;101(4):587–93.CrossRefPubMed
19.
Schwarz CE, Preusche A, Baden W, Poets CF, Franz AR. Repeatability of echocardiographic parameters to evaluate the hemodynamic relevance of patent ductus arteriosus in preterm infants: a prospective observational study. BMC Pediatr. 2016;16:18.CrossRefPubMedPubMedCentral
20.
Naulaers G, Meyns B, Miserez M, Leunens V, Van Huffel S, Casaer P, Weindling M, Devlieger H. Use of tissue oxygenation index and fractional tissue oxygen extraction as non-invasive parameters for cerebral oxygenation. A validation study in piglets. Neonatology. 2007;92(2):120–6.CrossRefPubMed
21.
Verhagen EA, Van Braeckel KN, van der Veere CN, Groen H, Dijk PH, Hulzebos CV, Bos AF. Cerebral oxygenation is associated with neurodevelopmental outcome of preterm children at age 2 to 3 years. Dev Med Child Neurol. 2015;57(5):449–55.CrossRefPubMed
22.
Lemmers PM, Benders MJ, D'Ascenzo R, Zethof J, Alderliesten T, Kersbergen KJ, Isgum I, de Vries LS, Groenendaal F, van Bel F. Patent ductus arteriosus and brain volume. Pediatrics. 2016;137(4):e20153090.CrossRefPubMed
23.
Hou X, Ding H, Teng Y, Zhou C, Tang X, Li S, Ding H. Research on the relationship between brain anoxia at different regional oxygen saturations and brain damage using near-infrared spectroscopy. Physiol Meas. 2007;28(10):1251–65.CrossRefPubMed
24.
Lemmers PM, Molenschot MC, Evens J, Toet MC, van Bel F. Is cerebral oxygen supply compromised in preterm infants undergoing surgical closure for patent ductus arteriosus? Arch Dis Child Fetal Neonatal Ed. 2010;95(6):F429–34.CrossRefPubMed
25.
Chock VY, Ramamoorthy C, Van Meurs KP. Cerebral oxygenation during different treatment strategies for a patent ductus arteriosus. Neonatology. 2011;100(3):233–40.CrossRefPubMed
26.
Zaramella P, Freato F, Quaresima V, Ferrari M, Bartocci M, Rubino M, Falcon E, Chiandetti L. Surgical closure of patent ductus arteriosus reduces the cerebral tissue oxygenation index in preterm infants: a near-infrared spectroscopy and Doppler study. Pediatr Int. 2006;48(3):305–12.CrossRefPubMed
27.
Huning BM, Asfour B, Konig S, Hess N, Roll C. Cerebral blood volume changes during closure by surgery of patent ductus arteriosus. Arch Dis Child Fetal Neonatal Ed. 2008;93(4):F261–4.CrossRefPubMed
28.
Vanderhaegen J, De Smet D, Meyns B, Van De Velde M, Van Huffel S, Naulaers G. Surgical closure of the patent ductus arteriosus and its effect on the cerebral tissue oxygenation. Acta Paediatr. 2008;97(12):1640–4.CrossRefPubMed
29.
Alderliesten T, Dix L, Baerts W, Caicedo A, van Huffel S, Naulaers G, Groenendaal F, van Bel F, Lemmers P. Reference values of regional cerebral oxygen saturation during the first 3 days of life in preterm neonates. Pediatr Res. 2016;79(1–1):55–64.CrossRefPubMed
30.
Kleiser S, Hyttel-Sorensen S, Greisen G, Wolf M. Comparison of near-infrared oximeters in a liquid optical phantom with varying Intralipid and blood content. Adv Exp Med Biol. 2016;876:413–8.CrossRefPubMed
31.
Cohen E, Baerts W, Alderliesten T, Derks J, Lemmers P, van Bel F. Growth restriction and gender influence cerebral oxygenation in preterm neonates. Arch Dis Child Fetal Neonatal Ed. 2016;101(2):F156–61.CrossRefPubMed
32.
Cohen E, Dix L, Baerts W, Alderliesten T, Lemmers P, van Bel F. Reduction in cerebral oxygenation due to patent ductus arteriosus is pronounced in small-for-gestational-age neonates. Neonatology. 2016;111(2):126–32.CrossRefPubMed
33.
Petrova A, Bhatt M, Mehta R. Regional tissue oxygenation in preterm born infants in association with echocardiographically significant patent ductus arteriosus. J Perinatol. 2011;31(7):460–4.CrossRefPubMed
Metadata
Title
Prospective observational study on assessing the hemodynamic relevance of patent ductus arteriosus with frequency domain near-infrared spectroscopy
Authors
Christoph E. Schwarz
Antonio Preusche
Martin Wolf
Christian F. Poets
Axel R. Franz
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2018
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-018-1054-6

Other articles of this Issue 1/2018

BMC Pediatrics 1/2018 Go to the issue

Research article

No effect of adding dairy lipids or long chain polyunsaturated fatty acids on formula tolerance and growth in full term infants: a randomized controlled trial

Research article

High-dose of intravenous immunoglobulin modulates immune tolerance in premature infants

Research article

Elevated central venous pressure is associated with increased mortality in pediatric septic shock patients

Study protocol

Effectiveness of intravenous immunoglobulin alone and intravenous immunoglobulin combined with high-dose aspirin in the acute stage of Kawasaki disease: study protocol for a randomized controlled trial

Research article

Ursodeoxycholic acid versus phenobarbital for cholestasis in the Neonatal Intensive Care Unit

Research article

Patterns and outcome of acute poisoning among children in rural Sri Lanka