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.

  • Original Article
  • Published:

Regional tissue oxygenation in preterm born infants in association with echocardiographically significant patent ductus arteriosus

Journal of Perinatology volume 31, pages 460–464 (2011)Cite this article

Subjects

Abstract

Objective:

To analyze the levels of regional tissue oxygenation in preterm infants in association with echocardiographically significant patent ductus arteriosis (PDA).

Study Design:

Preterm infants with gestational age less than 32 week were enrolled before the first dose of the pharmacological treatment for the PDA. Non-invasive near-infrared spectroscopy (NIRS) technology was utilized to measure cerebral (rSO2-C), renal (rSO2-R) and mesenteric (rSO2-M) tissue oxygenation for approximately 60 min. Regional fractional oxygen extraction (FOE) was calculated using simultaneously measured arterial saturation (SaO2). We analyzed regional tissue oxygenation and oxygen extraction, hemodynamic parameters, and demographic and clinical information in association with the size of the PDA (moderate vs large).

Result:

Among the 38 enrolled infants, the majority were diagnosed with a large (63.2%, n=24) and the rest with a moderate-sized PDA. Infants with large and moderate PDA were comparable in terms of gestational age, study age and weight, mode of delivery and hemodynamic parameters. A significantly higher proportion of infants with a moderate PDA were mechanically ventilated as compared with those with a large PDA. We found no significant differences in the rSO2-C and rSO2-R, irrespective of the type of respiratory support. However, in infants with a large PDA on continuous nasal positive airway pressure (NCPAP), the rSO2-M was lower and mesenteric FOE was higher than that in mechanically ventilated neonates with a large PDA, and in those with moderate PDA irrespective of the type of respiratory support.

Conclusion:

The PDA size did not affect cerebral and renal tissue oxygenation, but the mesenteric tissue oxygenation was decreased in infants with a large PDA on NCPAP.

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

Similar content being viewed by others

References

  1. Markham M . Patent ductus arteriosus in the premature infant: a clinical dilemma. Newborn Infant Nurs Rev 2006; 6: 151–157.

    Article  Google Scholar 

  2. Evans N, Iyer P . Assessment of ductus arteriosus shunt in preterm infants supported by mechanical ventilation: effect of inter-atrial shunting. J Pediatr 1994; 125: 778–785.

    Article  CAS  PubMed  Google Scholar 

  3. Reese J . Death, dying, and exhaustion in the ductus arteriosus: prerequisites for permanent closure. Editorial Focus. Am J Physiol Regul Integr Comp Physiol 2006; 290: R357–R358.

    Article  CAS  PubMed  Google Scholar 

  4. Agarwal R, Deorari AK, Paul VK . Patent ductis arteriosus in preterm neonates. Indian J Pediatr 2008; 75: 277–280.

    Article  PubMed  Google Scholar 

  5. 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 

  6. 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 

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

    Article  CAS  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  9. Petrova A, Mehta R . Near-infrared spectroscopy in the detection of regional tissue oxygenation during hypoxic events in preterm infants undergoing critical care. Pediatr Crit Care Med 2006; 7: 449–454.

    Article  PubMed  Google Scholar 

  10. Hoffman GM, Stuth EA, Jaquiss RD, Vanderwal PL, Staudt SR, Troshynski TJ et al. Changes in cerebral and somatic oxygenation during stage 1 palliation of hypoplastic left heart syndrome using continuous regional cerebral perfusion. J Thorac Cardiovasc Surg 2004; 127: 223–233.

    Article  PubMed  Google Scholar 

  11. Varela JE, Cohn SM, Giannotti GD, Dolich MO, Ramon H, Wiseberg JA et al. Near-infrared spectroscopy reflects changes in mesenteric and systemic perfusion during abdominal compartment syndrome. Surgery 2001; 129: 363–370.

    Article  CAS  PubMed  Google Scholar 

  12. Kocsis L, Herman P, Eke A . Mathematical model for the estimation of hemodynamic and oxygenation variables by tissue spectroscopy. J Theor Biol 2006; 241: 262–275.

    Article  CAS  PubMed  Google Scholar 

  13. Kleinman CS, Seri I, Victor S, Weindling MA . Near-infrared spectroscopy and its use for the assessment of tissue perfusion in the neonates. In: Kleinman CS, Seri I (eds). Hemodynamics and Cardiology. Elsevier Health Sciences: Philadephia, PA, 2008, pp 111–130.

    Google Scholar 

  14. Boushel R, Langberg H, Olesen J, Gonzales-Alonzo J, Bülow J, Kjaer M . Monitoring tissue oxygen availability with near infrared spectroscopy (NIRS) in health and disease. Scand J Med Sci Sports 2001; 11: 213–222.

    Article  CAS  PubMed  Google Scholar 

  15. Franceschini MA, Boas DA, Zourabian A, Diamond SG, Nadgir S, Lin DW et al. Near-infrared spirometry: noninvasive measurements of venous saturation in piglets and human subjects. J Appl Physiol 2002; 92: 372–384.

    Article  PubMed  Google Scholar 

  16. Abdul-Khaliq H, Troitzsch D, Berger F, Lange PE . Regional transcranial oximetry with near infrared spectroscopy (NIRS) in comparison with measuring oxygen saturation in the jugular bulb in infants and children for monitoring cerebral oxygenation. Biomed Technol (Berl) 2000; 45: 328–332.

    Article  CAS  Google Scholar 

  17. Bay-Hansen R, Elfving B, Greisen G . Use of near infrared spectroscopy for estimation of peripheral venous saturation in newborns: comparison with co-oximetry of central venous blood. Biol Neonate 2002; 82: 1–8.

    Article  PubMed  Google Scholar 

  18. Wickramasinghe YA, Livera LN, Spencer SA, Rolfe P, Thorniley MS . Plethysmographic validation of near infrared spectroscopic monitoring of cerebral blood volume. Arch Dis Child 1992; 67: 407–411.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Tichauer KM, Brown DW, Hadway J, Lee TY, St Lawrence K . Near-infrared spectroscopy measurements of cerebral blood flow and oxygen consumption following hypoxia–ischemia in newborn piglets. J Appl Physiol 2006; 100: 850–857.

    Article  PubMed  Google Scholar 

  20. Kaufman J, Almodovar MC, Zuk J, Friesen RH . Correlation of abdominal site near-infrared spectroscopy with gastric tonometry in infants following surgery for congenital heart disease. Pediatr Crit Care Med 2008; 9: 62–68.

    Article  PubMed  Google Scholar 

  21. Petros AJ, Heys R, Tasker RC, Fortune PM, Roberts I, Kiely E . Near infrared spectroscopy can detect changes in splanchnic oxygen delivery in neonates during apnoeic episodes. Eur J Pediatr 1999; 158: 173–174.

    Article  CAS  PubMed  Google Scholar 

  22. Fortune PM, Wagstaff M, Petros AJ . Cerebro-splanchnic oxygenation ratio (CSOR) using near infrared spectroscopy may be able to predict splanchnic ischaemia in neonates. Intens Care Med 2001; 27: 1401–1407.

    Article  CAS  Google Scholar 

  23. Wardle SP, Yoxall CW, Weindling AM . Determinants of cerebral fractional oxygen extraction using near infrared spectroscopy in preterm neonates. J Cereb Blood Flow Metab 2000; 20: 272–279.

    Article  CAS  PubMed  Google Scholar 

  24. Owen-Reece H, Smith M, Elwell CE, Goldstone JC . Near infrared spectroscopy. Br J Anaesth 1999; 82: 418–426.

    Article  CAS  PubMed  Google Scholar 

  25. Poets CF, Stebbens VA, Alexander JR, Arrowsmith WA, Salfield SA, Southall DP . Arterial oxygen saturation in preterm infants at discharge from the hospital and six weeks later. J Pediatr 1992; 120: 447–454.

    Article  CAS  PubMed  Google Scholar 

  26. Martin RM, Abu-Shaweesh JM, Baird MT . Apnea of prematurity. Pediatr Resp Rev 2004; 5: S377–S382.

    Article  Google Scholar 

  27. Miall-Allen VM, de Vries LS, Whitelaw AG . Mean arterial blood pressure and neonatal cerebral lesions. Arch Dis Child 1987; 62: 1068–1069.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Schears G, Schultz SE, Creed J, Greeley WJ, Wilson DF, Pastuszko A . Effect of perfusion flow rate on tissue oxygenation in newborn piglets during cardiopulmonary bypass. Ann Thorac Surg 2003; 75: 560–565.

    Article  PubMed  Google Scholar 

  29. Havranek T, Thompson Z, Carver JD . Factors that influence mesenteric artery blood flow velocity in newborn preterm infants. J Perinatol 2006; 26: 493–497.

    Article  CAS  PubMed  Google Scholar 

  30. Havranek T, Madramootoo C, Carver JD . Nasal continuous positive airway pressure affects pre- and postprandial intestinal blood flow velocity in preterm infants. J Perinatol 2007; 27: 704–708.

    Article  CAS  PubMed  Google Scholar 

  31. Loick HM, Tokyay R, Abdi S, Traber DL, Nichols RJ, Herndon DL . Halothane markedly reduces mesenteric blood flow but does not impair gut mucosal oxygenation in pigs. Eur J Pharmacol 1991; 16: 91–96.

    Article  Google Scholar 

  32. Cortez J, Gupta M, Amaram A, Pizzino J, Sawhney M, Sood BG . Noninvasive evaluation of splanchnic tissue oxygenation using near-infrared spectroscopy in preterm neonates. J Matern Fetal Neonatal Med 2010 (e-pub ahead of print).

  33. McNeill S, Gatenby JC, McElroy S, Engelhardt B . Normal cerebral, renal and abdominal regional oxygen saturations using near-infrared spectroscopy in preterm infants. J Perinatol 2010; 31: 51–57.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Lemmers PM, Toet MC, van Bel F . Impact of patent ductus arteriosus and subsequent therapy with indomethacin on cerebral oxygenation in preterm infants. Pediatrics 2008; 121: 142–147.

    Article  PubMed  Google Scholar 

  35. Zaramella P, Freato F, Quaresima V, Ferrari M, Bartocci M, Rubino M et al. Surgical closure of patent ductus arteriosus reduces the cerebral tissue oxygenation index in preterm infants: a near-infrared spectroscopy and Doppler study. Pediatr Int 2006; 48: 305–312.

    Article  PubMed  Google Scholar 

  36. Naulaers G, Morren G, Van Huffel S, Casaer P, Devlieger H . Measurement of tissue oxygenation index during the first three days in premature born infants. Adv Exp Med Biol 2003; 510: 379–383.

    Article  PubMed  Google Scholar 

  37. Kishi K, Kawaguchi M, Yoshitani K, Nagahata T, Furuya H . Influence of patient variables and sensor location on cerebral oxygen saturation measured by INVOS 4100 near-infrared spectrophotometers. J Neurosurg Anesthesiol 2003; 4: 302–306.

    Article  Google Scholar 

  38. Vanderhaegen J, Dehing L, Naulaers G, Devlieger H, Al-Olayet Y, Penninckx F et al. Use of the liver tissue oxygenation index as a noninvasive parameter of intestinal ischemia in rabbits. World J Surg 2007; 31: 2359–2362El.

    Article  CAS  PubMed  Google Scholar 

  39. Desoky E, Seifalian A, Cope M, Delpy D, Davidson B . Changes in tissue oxygenation of the porcine liver measured by near-infrared spectroscopy. Liver Transpl Surg 1999; 5: 219–226.

    Article  PubMed  Google Scholar 

  40. Meier SD, Eble BK, Stapleton GE, Morales DL, Chang AC, Andropoulos DB . Mesenteric oxyhemoglobin desaturation improves with patent ductus arteriosus ligation. J Perinatol 2006; 26: 562–564.

    Article  CAS  PubMed  Google Scholar 

  41. Stapleton GE, Eble BK, Dickerson HA, Andropoulos DB, Chang AC . Mesenteric oxygen desaturation in an infant with congenital heart disease and necrotizing enterocolitis. Tex Heart Inst J 2007; 34: 442–444.

    PubMed  PubMed Central  Google Scholar 

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

    Article  Google Scholar 

Download references

Acknowledgements

We would like to express our most sincere appreciation for the infants and their families for participation and commitment to this research project. This study was funded in part by a grant from Ovation Pharmaceuticals.

Contributor's Statement Page

Each of the three co-authors has made substantive intellectual contribution to the study (conception and design, acquisition of data, or analysis and interpretation of data, drafting of the manuscript or revising it critically for important intellectual content) and takes public responsibility for appropriate portions of the content of the manuscript.

Author information

Authors and Affiliations

  1. Department of Pediatrics, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    A Petrova, M Bhatt & R Mehta

Authors
  1. A Petrova
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M Bhatt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A Petrova.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Petrova, A., Bhatt, M. & Mehta, R. Regional tissue oxygenation in preterm born infants in association with echocardiographically significant patent ductus arteriosus. J Perinatol 31, 460–464 (2011). https://doi.org/10.1038/jp.2010.200

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2010.200

Keywords

This article is cited by

Search

Advanced search

Quick links