Patent Ductus Arteriosus and the Immature Brain: Is Early Intervention Protective?

Abstract

* Abbreviations: NIRS — : near-infrared spectroscopy PDA — : patent ductus arteriosus rSco2 — : regional cerebral oxygenation saturation Patent ductus arteriosus (PDA), in which the ductus arteriosus fails to close after birth, is a common congenital heart defect in premature infants.1 The optimal management of a hemodynamically significant PDA, in terms of the indications for closure, timing of closure, and role of surgery, has been debated for decades. Although diastolic runoff and left-to-right shunting in the presence of a significant PDA have been postulated to compromise blood flow to the immature brain and other structures, resulting in increased morbidity and mortality,2–4 some studies have shown that surgical PDA closure may contribute to perioperative hemodynamic instability,5 neurosensory complications,6,7 and even increased risk for worse neurodevelopmental outcome.8 In this issue of Pediatrics, Lemmers et al9 present a retrospective comparison of cerebral oxygenation, as measured by near-infrared spectroscopy (NIRS), and MRI-assessed regional brain volume and myelination in 3 groups of premature infants. One group underwent successful early closure of a PDA with 1 or 2 doses of indomethacin; pharmacological closure failed in the second group, and they underwent surgical ligation; and the third group of … Address correspondence to Lara S. Shekerdemian, MB ChB, MD, MHA, Baylor College of Medicine, Section Head of Critical Care, Texas Children’s Hospital, 6621 Fannin St, Suite W6006, Houston, TX 77030. E-mail: lssheker{at}texaschildrens.org