PMID- 32434188
OWN - NLM
STAT- MEDLINE
DCOM- 20210831
LR  - 20210831
IS  - 1661-7819 (Electronic)
IS  - 1661-7800 (Print)
IS  - 1661-7800 (Linking)
VI  - 117
IP  - 2
DP  - 2020
TI  - Cerebral Hemodynamics Are Not Affected by the Size of the Patent Ductus 
      Arteriosus.
PG  - 182-188
LID - 10.1159/000506835 [doi]
AB  - INTRODUCTION: Although patent ductus arteriosus (PDA) has been implicated to play 
      a role in the development of cerebral ischemia and intraventricular hemorrhage 
      (IVH) through a cerebral steal phenomenon, there is conflicting data on the 
      impact of PDA size on cerebral blood flow (CBF). Cerebral autoregulation is the 
      brain's innate protective mechanism to maintain constant CBF despite changes in 
      blood pressure, and it is unclear if it is influenced by PDA hemodynamics. 
      OBJECTIVE: To delineate the relationship between PDA size and CBF velocity (CBFv) 
      in premature infants. METHODS: 113 premature infants born at 23-29 weeks' 
      gestation had echocardiograms performed during the first week after birth to 
      evaluate for PDA. The infants were divided into 3 groups according to PDA size: 
      none-to-small, moderate, or large. All infants had continuous recordings of 
      umbilical artery blood pressure (ABP) and CBFv during the first week after birth. 
      Critical closing pressure (CrCP) was calculated from ABP and CBFv tracings. 
      Diastolic closing margin (DCM), defined as diastolic blood pressure minus CrCP, 
      was calculated as a marker for the risk of developing IVH. RESULTS: Infants with 
      a large PDA (n = 16) had the lowest ABP across all phases of the cardiac cycle 
      (systole [p = 0.003], mean [p = 0.005], and diastole [p = 0.012]) compared to 
      infants with a moderate (n = 19) or none-to-small PDA (n = 78). Despite blood 
      pressure being different, systolic, mean, and diastolic CBFv were not different 
      across groups. Cerebral autoregulation, as measured during systole, was intact 
      regardless of the PDA size. CrCP and DCM were also not different across groups. 
      CONCLUSIONS: In this cohort, CBFv and cerebral autoregulation during systole were 
      not influenced by PDA size. Intact cerebral autoregulation may play a role in 
      maintaining CBFv regardless of PDA size and differences in ABP.
CI  - (c) 2020 S. Karger AG, Basel.
FAU - Kim, Eun Sun
AU  - Kim ES
AD  - Department of Pediatrics, Kangwon National University School of Medicine, 
      Chuncheon, Republic of Korea, naivesun1@hanmail.net.
FAU - Kaiser, Jeffrey R
AU  - Kaiser JR
AD  - Division of Neonatal-Perinatal Medicine, Departments of Pediatrics and Obstetrics 
      and Gynecology, Penn State Health Children's Hospital, Hershey, Pennsylvania, 
      USA.
FAU - Rios, Danielle R
AU  - Rios DR
AD  - Section of Neonatology, Department of Pediatrics,Texas Children's Hospital/Baylor 
      College of Medicine, Houston, Texas, USA.
FAU - Bornemeier, Renee A
AU  - Bornemeier RA
AD  - Department of Pediatrics, Arkansas Children's Hospital/University of Arkansas for 
      Medical Sciences, Little Rock, Arkansas, USA.
FAU - Rhee, Christopher J
AU  - Rhee CJ
AD  - Section of Neonatology, Department of Pediatrics,Texas Children's Hospital/Baylor 
      College of Medicine, Houston, Texas, USA.
LA  - eng
GR  - P20 RR020146/RR/NCRR NIH HHS/United States
GR  - K23 NS091382/NS/NINDS NIH HHS/United States
GR  - K23 NS043185/NS/NINDS NIH HHS/United States
GR  - R01 NS060674/NS/NINDS NIH HHS/United States
GR  - K23 HL130522/HL/NHLBI NIH HHS/United States
GR  - UL1 RR029884/RR/NCRR NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20200520
PL  - Switzerland
TA  - Neonatology
JT  - Neonatology
JID - 101286577
SB  - IM
MH  - *Ductus Arteriosus, Patent/diagnostic imaging
MH  - Hemodynamics
MH  - Humans
MH  - Infant, Low Birth Weight
MH  - Infant, Newborn
MH  - Infant, Premature
MH  - *Infant, Premature, Diseases
PMC - PMC7381380
MID - NIHMS1585392
OTO - NOTNLM
OT  - Cerebral autoregulation
OT  - Cerebral blood flow velocity
OT  - Patent ductus arteriosus
OT  - Premature infant
COIS- Disclosure Statement The authors declare no conflicts of interest
EDAT- 2020/05/21 06:00
MHDA- 2021/09/01 06:00
PMCR- 2021/05/20
CRDT- 2020/05/21 06:00
PHST- 2019/10/24 00:00 [received]
PHST- 2020/02/26 00:00 [accepted]
PHST- 2020/05/21 06:00 [pubmed]
PHST- 2021/09/01 06:00 [medline]
PHST- 2020/05/21 06:00 [entrez]
PHST- 2021/05/20 00:00 [pmc-release]
AID - 000506835 [pii]
AID - 10.1159/000506835 [doi]
PST - ppublish
SO  - Neonatology. 2020;117(2):182-188. doi: 10.1159/000506835. Epub 2020 May 20.