Document Detail

Is cerebral oxygen supply compromised in preterm infants undergoing surgical closure for patent ductus arteriosus?
MedLine Citation:
PMID:  20584797     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: A haemodynamically important patent ductus arteriosus (PDA) is a risk factor for brain damage in preterm infants. The authors previously reported lower regional cerebral oxygen saturation (rScO(2)) in infants with PDA, which recovered after administration of indomethacin. However, PDA ligation has been reported to pose an even higher risk of neurodevelopmental impairment.
OBJECTIVE: To investigate the impact of surgical closure of PDA on rScO(2) and cerebral fractional tissue oxygen extraction (cFTOE), measured by near-infrared spectroscopy, and on amplitude-integrated electro-encephalography (aEEG) measured brain activity.
DESIGN/METHODS: In 20 preterm infants (gestational age 24.7-30.4 weeks; birth weight 630-1540 g), blood pressure, arterial saturation, rScO(2), cFTOE and aEEG were monitored before, during and up to 24 h after surgery.
RESULTS: Before surgery, median (range) rScO(2) was 53% (41-68%), and during surgery, but before ductal clipping, it was 46% (31-89%). Eleven infants showed a drop in blood pressure and 13 infants a drop in rScO(2) during surgery (range 2-21%), accompanied by a decrease in aEEG amplitude. Twelve infants had rScO(2) values below 50% during surgery, with five being below 40%. Only at 24 h after surgery was rScO(2) higher (61% (36-85%), p<0.05) and cFTOE values lower (0.38 (0.09-0.61); p<0.05) compared with preclipping values.
CONCLUSION: Ductal ligation poses a risk for a further decrease in already compromised cerebral oxygenation in preterm infants.
Petra M A Lemmers; Mirella C Molenschot; Jola Evens; Mona C Toet; Frank van Bel
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Publication Detail:
Type:  Journal Article     Date:  2010-06-28
Journal Detail:
Title:  Archives of disease in childhood. Fetal and neonatal edition     Volume:  95     ISSN:  1468-2052     ISO Abbreviation:  Arch. Dis. Child. Fetal Neonatal Ed.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-27     Completed Date:  2010-12-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9501297     Medline TA:  Arch Dis Child Fetal Neonatal Ed     Country:  England    
Other Details:
Languages:  eng     Pagination:  F429-34     Citation Subset:  AIM; IM    
Department of Neonatology, University Medical Center/Wilhelmina Children's Hospital, Utrecht, The Netherlands.
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MeSH Terms
Blood Pressure / physiology
Brain / blood supply*,  metabolism
Cerebrovascular Circulation / physiology
Ductus Arteriosus, Patent / physiopathology,  surgery*
Electroencephalography / methods
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases / physiopathology,  surgery*
Intraoperative Period
Monitoring, Intraoperative / methods
Oxygen / blood
Oxygen Consumption / physiology*
Prospective Studies
Reg. No./Substance:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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