Abstract
Background: Preterm infants with hemodynamically significant patent ductus arteriosus (HsPDA) are exposed to low cerebral tissue oxygen saturation (rScO2) values. Additionally, infants requiring surgical ligation are at risk of further changes in cerebral oxygenation and postligation cardiac syndrome (PLCS). Previous studies have assessed the effect of PDA ligation on rScO2 with variable results.Cases description: In this report we analyse near-infrared spectroscopy (NIRS) and echocardiographic findings of two patients who underwent ligation of PDA and presented low cardiac output. Literature on regional tissue oxygenation saturation (rSO2) before and after PDA ligation was briefly reviewed.Discussion: Cerebral oxygenation values before and after PDA ligation may be influenced by gestational age, vasopressor use, ductal shunt volume, time of exposure HsPDA, chronological age and the presence of cerebral autoregulation. PLCS complicates 28–45% of all PDA ligations and is associated with higher mortality. Cerebral and somatic NIRS monitoring in the postoperative period may enhance the identification of PLCS at early stages.Conclusion: Cerebral oxygenation in the perioperative period of PDA ligation may be influenced by numerous clinical factors. Early detection of PLCS using multisite NIRS after ligation could prevent further alterations in cerebral hemodynamics and improve outcomes. A decrease in somatic-cerebral difference and/or a significant drop in somatic NIRS values may precede clinical signs of hypoperfusion. NIRS values should be interpreted as trends along with echocardiographic findings to guide goal directed interventions.
Highlights
Preterm infants with hemodynamically significant patent ductus arteriosus (HsPDA) are exposed to low cerebral tissue oxygen saturation values
Renal tissue oxygen saturation values have not been monitored during surgical ligation of ductus arteriosus but have been reported to normalize after closure with indomethacin and ibuprofen [3,4,5]
These conflicting results suggest that cerebral oxygenation values before and after ductal closure may be influenced by gestational age, ductal shunt volume, time of exposure to ductal shunt, chronological age and the presence of cerebral autoregulation, as well as vasopressor use and previous pharmacological treatment
Summary
Preterm infants with hemodynamically significant patent ductus arteriosus (HsPDA) are exposed to low cerebral tissue oxygen saturation (rScO2) values. Infants requiring surgical ligation are at risk of further changes in cerebral oxygenation and postligation cardiac syndrome (PLCS). Preterm infants with HsPDA are exposed to low rScO2 which poses a risk of cerebral injury [1, 2]. An increased risk of neurosensory impairment has been reported in infants who underwent PDA surgical closure [1]. Previous studies have reported differing results regarding cerebral tissue oxygenation after PDA ligation. Renal tissue oxygen saturation (rSrO2) values have not been monitored during surgical ligation of ductus arteriosus but have been reported to normalize after closure with indomethacin and ibuprofen [3,4,5]
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