IS CEREBRAL OXYGEN SUPPLY COMPROMISED IN PRETERM INFANTS UNDERGOING CLOSURE OF PATENT DUCTUS ARTERIOSUS (PDA)?
Dr. Petra Lemmers
1 slide(s) – English – 2010-10-23
Background: A hemodynamically important PDA is associated with increased morbidity and should be closed pharmacological or surgical. Studies showed that surgical closure contains a risk for adverse neurodevelopmental outcome.
Objective: To monitor cerebral oxygenation by near-infrared spectroscopy (rScO2) in 3 groups of preterm infants: 9 controls without PDA (CTRL); 9 infants with pharmalogical closure (INDOI); and 9 infants with surgical closure (SURG). Monitoring started before treatment up to 48h after treatment. Infants were matched for GA, BW and severity of illness. Infants had volumetric 3D-MRI at 40wks to calculate cerebral tissue volumes.
Results: GA and BW of three groups were 26.9±0.6, 26.8±1.1 and 26.4±1.0wks, and 928±185, 917±155 and 896±141g respectively. Lowest mean rScO2 values±SD before/during treatment were 58±6% for INDO and 53±7% for SURG vs CTRLs: 65±5% (reference values: 63-71%), p< 0.001. Brain volumes are shown in table1. Linear regression between ventricle volume and rScO2 showed a negative correlation: r=-0.59, p< 0.01 and r=-0.74, p< 0.02 for SURG only.
[table1: * p<0.07 vs CTRL]
| ||Ventricle volume ||white matter ||gray matter ||total volume |
|CTRL ||11 ± 3 ||158 ± 22 ||160 ± 36 ||390 ± 33 |
|INDO ||12 ± 2 ||143 ± 15 ||161 ± 14 ||374 ± 20 |
|SURG ||15 ± 7* ||153 ± 18 ||153 ± 22 ||383 ± 29 |
Conclusion: Lowest rScO2´s were found in the SURG group, whereas ventricle volumes tended to be larger. This, and the reverse relation between rScO2 and ventricle volume in the SURG group may indicate hypoxia-induced brain tissue atrophy which (partly) explain the higher incidence of adverse outcome.