Cerebral and intestinal Doppler patterns according to patent ductus arteriosus shunt characteristics in preterm infants

Abstract

Background: A hemodynamically significant patent ductus arteriosus (hsPDA) is common in preterm infants and may impact systemic and cerebral blood flow. This study explores Doppler flow patterns in systemic arteries including celiac artery/trunk (CeT), superior mesenteric artery (SMA) and middle cerebral artery (MCA) in preterm neonates with varying PDA shunt patterns, utilizing targeted neonatal echocardiography (TNE). Methods: Retrospective multicenter study of preterm infants (born <32 weeks gestation, <40 days of life) who underwent comprehensive TNE. Infants were categorized into 3 groups based on PDA shunt characteristics as follows: (1) No transductal shunt or trivial PDA with PDA score <6, (2) Left-to-right PDA (L-R PDA) and PDA score ≥8 and (3) Bidirectional PDA shunt with at least 10% of time spent right-to-left (R-L) and PDA score <6. Results: In total, 86 patients with a median [IQR] gestational age of 26.1 weeks [23.8–27.7] weeks and birth weight of 767 [596, 1016] grams were included and classified into 3 groups: No PDA (n = 29), hsPDA (n = 48) and bidirectional PDA (n = 27). Abnormal systemic arterial Doppler patterns (absent or reversed diastolic flow in the Celiac artery) were present in 2 (5.7%), 15 (44.1%), and 1 (5.9%) of the patients in the no PDA, hsPDA, and bidirectional PDA groups respectively. Diastolic flow reversal in any of the systemic vessels evaluated was demonstrated only in the hsPDA group. Conclusion: This physiologic study demonstrates altered systemic Doppler patterns, which suggests a decreased ability to preserve lower body blood flow in premature infants with hsPDA. Further prospective studies are warranted to describe the association of these physiologic findings with clinical outcomes such as necrotizing enterocolitis. Clinical Trial Registration (if any): None (not applicable).