Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • State of the Art
  • Published:

State-of-the-Art

Spectral Doppler waveforms in systemic arteries and physiological significance of a patent ductus arteriosus

Journal of Perinatology volume 31, pages 150–156 (2011)Cite this article

Subjects

Abstract

Patent ductus arteriosus in extremely premature babies is associated with major neonatal morbidities, such as necrotizing enterocolitis and intraventricular hemorrhage. This may be attributable, at least in part, to systemic hypoperfusion secondary to ductal steal. A hemodynamically significant ductus arteriosus (HSDA) is known to be associated with altered systemic blood flow and end-organ hypoperfusion. Although descending aorta blood flow profiles may show abnormal diastolic retrograde flow, Doppler studies of blood flow in the systemic arteries may help improve our understanding of the relationship of a HSDA with these morbidities. In this article, we discuss aspects of diastolic blood flow reversal in the systemic arteries in premature infants with a hemodynamically significant duct. Whether these hemodynamic effects are significant enough to form the basis for initiating treatment is still unclear; these should form the basis for prospective studies.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

References

  1. Ellison RC, Peckham GJ, Lang GJP, Talner NS, Lerer TJ, Lin L et al. Evaluation of the preterm infant for patent ductus arteriosus. Pediatrics 1983; 71: 364–372.

    CAS  PubMed  Google Scholar 

  2. Clyman RI . Mechanisms regulating the ductus arteriosus. Biol Neonate 2006; 89: 330–335.

    Article  PubMed  Google Scholar 

  3. Kluckow M, Evans N . Early echocardiographic prediction of symptomatic patent ductus arteriosus in preterm infants undergoing mechanical ventilation. J Pediatr 1995; 127: 774–779.

    Article  CAS  PubMed  Google Scholar 

  4. Knight DB . The treatment of patent ductus arteriosus in preterm infants: a review and overview of randomized trials. Semin Neonatol 2001; 6: 63–73.

    Article  CAS  PubMed  Google Scholar 

  5. Armstrong DL, Teele RL, Kuschel CA, Harding JA . The use of renal Doppler ultrasonography to diagnose patent ductus arteriosus in preterm infants. J Ultrasound Med 2001; 20: 1005–1010.

    Article  CAS  PubMed  Google Scholar 

  6. Cassell DE . The Ductus Arteriosus 1973. Charles C Thomas: Springfield, IL; pp. 143–160.

    Google Scholar 

  7. Meyers RL, Alpan G, Lin E, Clyman RI . Patent ductus arteriosus, indomethacin and intestinal distension: effects on intestinal blood flow and oxygen consumption. Pediatr Res 1991; 29: 569–574.

    Article  CAS  PubMed  Google Scholar 

  8. McCurnin D, Clyman RI . Effects of a patent ductus arteriosus on postprandial mesenteric perfusion in premature baboons. Pediatrics 2008; 122 (6): e1262–e1267.

    Article  PubMed  Google Scholar 

  9. Baschat AA, Harman CR . Venous Doppler in the assessment of fetal cardiovascular status. Curr Opin Obstet Gynecol 2006; 18: 156–163.

    Article  PubMed  Google Scholar 

  10. Baschat AA, Cosmi E, Bilardo CM, Wolf H, Berg C, Rigano S et al. Predictors of neonatal outcome in early-onset placental dysfunction. Obstet Gynecol 2007; 109 (2): 253–260.

    Article  PubMed  Google Scholar 

  11. Baschat AA . Doppler application in the delivery timing of the preterm growth-restricted fetus: another step in the right direction. Ultrasound Obstet Gynecol 2004; 23: 111–118.

    Article  CAS  PubMed  Google Scholar 

  12. McCowan LM, Erskine LA, Ritchie K . Umbilical artery Doppler blood flow studies in the preterm, small for gestational age fetus. Am J Obstet Gynecol 1989; 96: 697–704.

    Google Scholar 

  13. Gudmundsson S, Marsal K . Umbilical and uteroplacental blood flow velocity waveforms in pregnancies with fetal growth retardation. Eur J Obstet Gynecol Reprod Biol 1988; 27: 187–196.

    Article  CAS  PubMed  Google Scholar 

  14. Weiner CP . The relationship between the umbilical artery systolic/diastolic ratio and umbilical blood gas measurements in specimens obtained by cordocentesis. Am J Obstet Gynecol 1990; 162: 1198–1202.

    Article  CAS  PubMed  Google Scholar 

  15. Bilardo CM, Nicolaides KH, Campbell S . Doppler measurements of fetal and uteroplacental circulations: relationship with umbilical venous blood gases measured at cordocentesis. Am J Obstet Gynecol 1990; 162: 115–120.

    Article  CAS  PubMed  Google Scholar 

  16. Keller HM, Meier WE, Kumpe DA . Non-invasive angiography for the diagnosis of vertebral artery disease using Doppler ultrasound (vertebral artery Doppler). Stroke 1976; 7: 364.

    Article  CAS  PubMed  Google Scholar 

  17. Patel A, Toole JF . Subclavian steal syndrome’ reversal of cephalic blood flow. Medicine 1965; 44: 289.

    Article  CAS  PubMed  Google Scholar 

  18. McNamara PJ, Sehgal A . Towards rational management of the patent ductus arteriosus: the need for disease staging. Arch Dis Child Fetal Neonatal Ed 2007; 92: F424–F427.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Shimada S, Kasai T, Hoshi A, Murata A, Chida S . Cardio-circulatory effects of patent ductus arteriosus in extremely low-birth-weight infants with respiratory distress syndrome. Pediatr Int 2003; 45: 255–262.

    Article  PubMed  Google Scholar 

  20. Swarup J, Baker RW, Brozanski BS, Yanowitz TD . Asymmetry of cerebral blood flow velocity in low birth weight infants. Biol Neonate 2005; 87: 145–151.

    Article  PubMed  Google Scholar 

  21. Evans N, Iyer P . Longitudinal changes in the diameter of the ductus arteriosus in ventilated preterm infants: correlation with respiratory outcomes. Arch Dis Child Fetal Neonatal Ed 1995; 72: F156–F161.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Spach MS, Serwer GA, Anderson PAW, Canent Jr RV, Levin AR . Pulsatile aortopulmonary pressure-flow dynamics of patent ductus arteriosus in patients with various hemodynamic states. Circulation 1980; 61: 110.

    Article  CAS  PubMed  Google Scholar 

  23. Rudolph AM, Scarpelli EM, Golinko RJ, Gootman NL . Hemodynamic basis for clinical manifestations of patent ductus arteriosus. Am Heart J 1964; 68: 447.

    Article  CAS  PubMed  Google Scholar 

  24. Lipman B, Serwer GA, Brazy JE . Abnormal cerebral hemodynamics in preterm infants with patent ductus arteriosus. Pediatrics 1982; 69: 778–781.

    CAS  PubMed  Google Scholar 

  25. Groves AM, Kuschel CA, Knight DB, Skinner JR . Echocardiographic assessment of blood flow volume in the superior vena cava and descending aorta in the newborn infant. Arch Dis Child Fetal Neonatal Ed 2008; 93: F24–F28.

    Article  CAS  PubMed  Google Scholar 

  26. Groves AM, Kuschel CA, Knight DB, Skinner JR . Does retrograde diastolic flow in the descending aorta signify impaired systemic perfusion in preterm infants? Pediatr Res 2008; 63 (1): 89–94.

    Article  PubMed  Google Scholar 

  27. Sehgal A, Mak W, Dunn M, Kelly E, Redington A, Whyte H et al. Haemodynamic changes after delivery room surfactant administration to very low birth weight infants. Arch Dis Child Fetal Neonatal Ed. 2010; [e-pub ahead of print 10 June 2010].

  28. Sehgal A, McNamara PJ . Coronary Artery Hypo-Perfusion Is Associated with Impaired Diastolic Dysfunction in Preterm Infants after Patent Ductus Arteriosus (PDA) Ligation. Pediatric Academic Societies Annual Meting: Toronto E-PAS2007:615896.15.

  29. Serwer GA, Armstrong BE, Anderson PAW . Non-invasive detection of retrograde descending aortic flow in infants using continuous wave Doppler ultrasonography. J Pediatr 1980; 97: 394.

    Article  CAS  PubMed  Google Scholar 

  30. Kluckow M, Evans N . Low superior vena cava flow and intraventricular haemorrhage in preterm infants. Arch Dis Child Fetal Neonatal Ed 2000; 82 (3): F188–F194.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. El-Khuffash A, Higgins M, Walsh K, Molloy EJ . Quantitative assessment of the degree of ductal steal using celiac artery blood flow to left ventricular output ratio in preterm infants. Neonatology 2008; 93: 206–212.

    Article  PubMed  Google Scholar 

  32. Drougia A, Giapros V, Krallis N, Theocharis P, Nikaki A, Tzoufi M et al. Incidence and risk factors for cerebral palsy in infants with perinatal problems: a 15-year review. Early Hum Dev 2007; 83: 541–547.

    Article  CAS  PubMed  Google Scholar 

  33. Marshall DD, Kotelchuck M, Young TE, Bose CL, Kruyer L, O’Shea TM . Risk factors for chronic lung disease in the surfactant era: a North Carolina population-based study of very low birth weight infants. North Carolina Neonatologists Association. Pediatrics 1999; 104: 1345–1350.

    Article  CAS  PubMed  Google Scholar 

  34. Redline RW, Wilson-Costello D, Hack M . Placental and other perinatal risk factors for chronic lung disease in very low birth weight infants. Pediatr Res 2002; 52: 713–719.

    Article  PubMed  Google Scholar 

  35. Ryder RW, Shelton JD, Guinan ME . Necrotizing enterocolitis: a prospective multicenter investigation. Am J Epidemiol 1980; 112: 113–123.

    Article  CAS  PubMed  Google Scholar 

  36. Dollberg S, Lusky A, Reichman B . Patent ductus arteriosus, indomethacin and necrotizing enterocolitis in very low birth weight infants: a population-based study. J Pediatr Gastroenterol Nutr 2005; 40: 184–188.

    Article  CAS  PubMed  Google Scholar 

  37. Kabra NS, Schmidt B, Roberts RS, Doyle LW, Papile L, Fanaroff A et al. Neurosensory impairment after surgical closure of patent ductus arteriosus in extremely low birth weight infants: results from the Trial of Indomethacin Prophylaxis in Preterms. J Pediatr 2007; 150: 229–234.

    Article  CAS  PubMed  Google Scholar 

  38. Wong SN, Lo RN, Hui PW . Abnormal renal and splanchnic arterial Doppler pattern in premature babies with symptomatic PDA. J Ultrasound Med 1990; 9 (3): 125–130.

    Article  CAS  PubMed  Google Scholar 

  39. Sehgal A, McNamara PJ . Echocardiographic markers of a haemodynamically significant ductus arteriosus. Eur J Pediatr 2009; 168 (8): 907–914.

    Article  PubMed  Google Scholar 

  40. Crispi F, Hernandez-Andrade E, Pelsers MM, Plasencia W, Benavides-Serralde JA, Eixarch E et al. Cardiac dysfunction and cell damage across clinical stages of severity in growth-restricted fetuses. Am J Obstet Gynecol 2008; 199 (3): 254.e 1–254.e 8.

    Article  Google Scholar 

  41. Benitz W . Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis. J Perinatol 2010; 30: 241–252.

    Article  CAS  PubMed  Google Scholar 

  42. Cowan F . Indomethacin, patent ductus arteriosus and cerebral blood flow. J Pediatr 1986; 109: 341–343.

    Article  CAS  PubMed  Google Scholar 

  43. Lundell BPW, Sonesson SE, Cotton RB . Ductus closure in preterm infants; effects on cerebral haemodynamics. Acta Paediatr Scand 1986; 329: 140–147.

    Article  CAS  Google Scholar 

  44. Coombs RC, Morgan MEI, Durbin GM, Booth IW, McNeish AS . Gut blood flow velocities in the newborn: effects of patent ductus arteriosus and indomethacin. Arch Dis Child 1990; 65: 1067–1071.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Akima S, Kent A, Reynolds GJ, Gallagher M, Falk MC . Indomethacin and renal impairment in neonates. Pediatr Nephrol 2004; 19 (5): 490–495.

    Article  PubMed  Google Scholar 

  46. Bel FV, Zoeren DV, Schipper J, Gult GL, Baan J . Effect of indomethacin on superior mesenteric artery blood flow velocity in preterm infants. J Pediatr 1990; 116: 965–970.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Monash Newborn, Monash Children's, Monash Medical Centre, Melbourne, VIC, Australia

    A Sehgal & K Tan

  2. Monash University, Melbourne, VIC, Australia

    A Sehgal & K Tan

  3. Department of Diagnostic Imaging, Monash Medical Centre, Melbourne, VIC, Australia

    P Coombs

  4. Department of Paediatrics Toronto, Physiology and Experimental Medicine Program, SickKids Research Institute, Toronto, ON, Canada

    P J McNamara

  5. Division of Neonatology, Department of Paediatrics Toronto, Toronto, ON, Canada

    P J McNamara

Authors
  1. A Sehgal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P Coombs
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P J McNamara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A Sehgal.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sehgal, A., Coombs, P., Tan, K. et al. Spectral Doppler waveforms in systemic arteries and physiological significance of a patent ductus arteriosus. J Perinatol 31, 150–156 (2011). https://doi.org/10.1038/jp.2010.83

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2010.83

Keywords

This article is cited by

Search

Advanced search

Quick links