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.

  • Article
  • Published:

Clinical validity of systemic arterial steal among extremely preterm infants with persistent patent ductus arteriosus

Journal of Perinatology volume 41, pages 84–92 (2021)Cite this article

Subjects

Abstract

Objective

Investigate relevance of diastolic flow abnormalities in celiac trunk (aCT) and middle cerebral artery (aMCA) among preterms with persistent hemodynamically significant patent ductus arteriosus (phsPDA, diameter ≥ 1.5 mm, and age ≥ 7 days).

Study design

Five hundred fifteen echocardiograms from 156 neonates born <28 weeks gestation age (GA) were analyzed retrospectively. Infants with aCT or aMCA at any time were compared with the rest. Separate comparisons were performed for aCT and aMCA. Primary outcome was composite of death, chronic lung disease (CLD), or necrotizing enterocolitis ≥ stage 2. Logistic regression was used to adjust for confounders.

Result

Mean (SD) weight and GA were 820(214) g and 25.2(1.3) weeks. aMCA, but not aCT, was associated with primary outcome [adjusted odds ratio 2.17, 95% CI: 1.01–4.67] and CLD [2.20 (0.99–4.87)].

Conclusion

aMCA may be a valid marker for defining the clinical significance of phsPDA in preterm neonates. aCeT may be of limited value in selecting patients for treatment.

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

Fig. 1: Doppler assessment of flow pattern in systemic arteries.

Similar content being viewed by others

References

  1. Zonnenberg I, de Waal K. The definition of a haemodynamic significant duct in randomized controlled trials: a systematic literature review. Acta Paediatr. 2012;101:247–51.

    Article  Google Scholar 

  2. Sehgal A, McNamara PJ. Does echocardiography facilitate determination of hemodynamic significance attributable to the ductus arteriosus? Eur J Pediatr. 2009;168:907–14.

    Article  Google Scholar 

  3. Kluckow M, Evans N. Early echocardiographic prediction of symptomatic patent ductus arteriosus in preterm infants undergoing mechanical ventilation. J Pediatr. 1995;127:774–9.

    Article  CAS  Google Scholar 

  4. El-Khuffash A, James AT, Corcoran JD, Dicker P, Franklin O, Elsayed YN, et al. A patent ductus arteriosus severity score predicts chronic lung disease or death before discharge. J Pediatr. 2015;167:1354–61.e2.

    Article  Google Scholar 

  5. Sehgal A, Paul E, Menahem S. Functional echocardiography in staging for ductal disease severity: role in predicting outcomes. Eur J Pediatr. 2013;172:179–84.

    Article  Google Scholar 

  6. Carlo WF, Kimball TR, Michelfelder EC, Border WL. Persistent diastolic flow reversal in abdominal aortic Doppler-flow profiles is associated with an increased risk of necrotizing enterocolitis in term infants with congenital heart disease. Pediatrics 2007;119:330–5.

    Article  Google Scholar 

  7. Coombs RC, Morgan ME, Durbin GM, Booth IW, McNeish AS. Gut blood flow velocities in the newborn: effects of patent ductus arteriosus and parenteral indomethacin. Arch Dis Child. 1990;65:1067–71.

    Article  CAS  Google Scholar 

  8. Shimada S, Kasai T, Konishi M, Fujiwara T. Effects of patent ductus arteriosus on left ventricular output and organ blood flows in preterm infants with respiratory distress syndrome treated with surfactant. J Pediatr. 1994;125:270–7.

    Article  CAS  Google Scholar 

  9. 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;93:206–12.

    Article  Google Scholar 

  10. Perlman JM, Hill A, Volpe JJ. The effect of patent ductus arteriosus on flow velocity in the anterior cerebral arteries: ductal steal in the premature newborn infant. J Pediatr. 1981;99:767–71.

    Article  CAS  Google Scholar 

  11. Weir FJ, Ohlsson A, Myhr TL, Fong K, Ryan ML. A patent ductus arteriosus is associated with reduced middle cerebral artery blood flow velocity. Eur J Pediatr. 1999;158:484–7.

    Article  CAS  Google Scholar 

  12. Hsu KH, Nguyen J, Dekom S, Ramanathan R, Noori S. Effects of patent ductus arteriosus on organ blood flow in infants born very preterm: a prospective study with serial echocardiography. J Pediatr. 2020;216:95–100.e2.

    Article  Google Scholar 

  13. Lee SK, McMillan DD, Ohlsson A, Pendray M, Synnes A, Whyte R, et al. Variations in practice and outcomes in the Canadian NICU network: 1996–1997. Pediatrics 2000;106:1070–9.

    Article  CAS  Google Scholar 

  14. Shah PS, Seidlitz W, Chan P, Yeh S, Musrap N, Lee SK, et al. Internal audit of the canadian neonatal network data collection system. Am J Perinatol. 2017;34:1241–9.

    Article  Google Scholar 

  15. Lipman B, Serwer GA, Brazy JE. Abnormal cerebral hemodynamics in preterm infants with patent ductus arteriosus. Pediatrics. 1982;69:778–81.

    CAS  PubMed  Google Scholar 

  16. Shortland DB, Gibson NA, Levene MI, Archer LN, Evans DH, Shaw DE. Patent ductus arteriosus and cerebral circulation in preterm infants. Dev Med Child Neurol. 1990;32:386–93.

    Article  CAS  Google Scholar 

  17. Martin CG, Snider AR, Katz SM, Peabody JL, Brady JP. Abnormal cerebral blood flow patterns in preterm infants with a large patent ductus arteriosus. J Pediatr. 1982;101:587–93.

    Article  CAS  Google Scholar 

  18. Wong SN, Lo RN, Hui PW. Abnormal renal and splanchnic arterial Doppler pattern in premature babies with symptomatic patent ductus arteriosus. J Ultrasound Med. 1990;9:125–30.

    Article  CAS  Google Scholar 

  19. Hoodbhoy SA, Cutting HA, Seddon JA, Campbell ME. Cerebral and splanchnic hemodynamics after duct ligation in very low birth weight infants. J Pediatr. 2009;154:196–200.

    Article  Google Scholar 

  20. Jim WT, Chiu NC, Chen MR, Hung HY, Kao HA, Hsu CH, et al. Cerebral hemodynamic change and intraventricular hemorrhage in very low birth weight infants with patent ductus arteriosus. Ultrasound Med Biol. 2005;31:197–202.

    Article  Google Scholar 

  21. Schena F, Francescato G, Cappelleri A, Picciolli I, Mayer A, Mosca F, et al. Association between hemodynamically significant patent ductus arteriosus and Bronchopulmonary Dysplasia. J Pediatr. 2015;166:1488–92.

    Article  Google Scholar 

  22. Broadhouse KM, Price AN, Durighel G, Cox DJ, Finnemore AE, Edwards AD, et al. Assessment of PDA shunt and systemic blood flow in newborns using cardiac MRI. NMR Biomed. 2013;26:1135–41.

    Article  Google Scholar 

  23. Louis D, Mukhopadhyay K, Sodhi KS, Jain V, Kumar P. Superior mesenteric artery Doppler is poor at predicting feed intolerance and NEC in preterm small for gestational age neonates. J Matern Fetal Neonatal Med. 2013;26:1855–9.

    Article  Google Scholar 

  24. Clyman R, Wickremasinghe A, Jhaveri N, Hassinger DC, Attridge JT, Sanocka U, et al. Enteral feeding during indomethacin and ibuprofen treatment of a patent ductus arteriosus. J Pediatr. 2013;163:406–11.

    Article  CAS  Google Scholar 

  25. Sellmer A, Bjerre JV, Schmidt MR, McNamara PJ, Hjortdal VE, Host B, et al. Morbidity and mortality in preterm neonates with patent ductus arteriosus on day 3. Arch Dis Child Fetal Neonatal Ed. 2013;98:F505–10.

    Article  Google Scholar 

  26. Benitz WE. Learning to live with patency of the ductus arteriosus in preterm infants. J Perinatol. 2011;31:S42–8.

    Article  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge the contribution of Mr Junmin Yang Msc, Statistician, MiCare Research Center, Mount Sinai Hospital, University of Toronto for conducting the statistical analysis for this study and the Canadian Neonatal Network for providing the demographic and clinical outcome data of study infants.

Author information

Authors and Affiliations

  1. Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada

    Lieke Keusters, Jyotsna Purna, Poorva Deshpande, Prakeshkumar Shah & Amish Jain

  2. Department of Paediatrics, University of Toronto, Toronto, ON, Canada

    Poorva Deshpande, Luc Mertens, Prakeshkumar Shah, Patrick J. McNamara, Dany E. Weisz & Amish Jain

  3. Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada

    Luc Mertens & Patrick J. McNamara

  4. Lunnenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada

    Prakeshkumar Shah & Amish Jain

  5. Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Prakeshkumar Shah

  6. Department of Physiology, University of Toronto, Toronto, ON, Canada

    Patrick J. McNamara & Amish Jain

  7. Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Dany E. Weisz

Authors
  1. Lieke Keusters
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jyotsna Purna
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Poorva Deshpande
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luc Mertens
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Prakeshkumar Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Patrick J. McNamara
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dany E. Weisz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Amish Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AJ drafted the research question, AJ and DEW designed the study design and concept, PD, LM, PS, and PJM reviewed and made significant intellectual contribution to the research design. LK, PD, and JP also contributed to research methodology and acquired the study data and prepared files for analysis. AJ, LM, and PS also contributed resources toward the conduct and completion of this project. All authors made significant contribution to the interpretation of the results. AJ and DEW prepared the initial draft of the paper, while PD, LK, JP, LM, PS, and PJM reviewed the paper and provided significant critical revisions. All authors approved the final paper and accept responsibility for all elements of this paper.

Corresponding author

Correspondence to Amish Jain.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Keusters, L., Purna, J., Deshpande, P. et al. Clinical validity of systemic arterial steal among extremely preterm infants with persistent patent ductus arteriosus. J Perinatol 41, 84–92 (2021). https://doi.org/10.1038/s41372-020-0663-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-020-0663-8

This article is cited by

Search

Advanced search

Quick links