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.

  • Perspective
  • Published:

The often forgotten systemic effects of ductus arteriosus: impact on decision-making and future trials

Journal of Perinatology volume 41, pages 2363–2366 (2021)Cite this article

Subjects

Abstract

Respiratory symptomatology and echocardiographic features of pulmonary circulation exclusively guide therapy for a hemodynamically significant patent ductus arteriosus in preterm infants. Interrogations of systemic artery Doppler or the exploration of their links with respective end organ symptomatology is not routine practice. This brief report shows the relevance of ‘systemic’ symptoms and the assessment of ‘systemic hypo-perfusion’ (and their resolution with physiologically appropriate therapy) in decision-making. Future trials should include this often-ignored aspect in study designs and/or post-hoc analysis.

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
Fig. 2: Renal artery Dopplers showing reversal and restoration in diastolic flow.

Similar content being viewed by others

References

  1. Noori S. Patent ductus arteriosus in the preterm infant: to treat or not to treat? J Perinatol. 2010;30:S31–7.

    Article  Google Scholar 

  2. Sehgal A, McNamara PJ. International perspective on management of a patent ductus arteriosus: lessons learned. Semin Fetal Neonatal Med. 2018;23:278–84.

    Article  Google Scholar 

  3. Teixeira LS, McNamara PJ. Enhanced intensive care for the neonatal ductus arteriosus. Acta Paediatr. 2006;95:394–403.

    Article  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  Google Scholar 

  5. Sehgal A, Coombs P, Tan K, McNamara PJ. Spectral Doppler waveforms in systemic arteries and physiological significance of a patent ductus arteriosus. J Perinatol. 2011;31:150–6.

    Article  CAS  Google Scholar 

  6. Cassels DE. The ductus arteriosus. Charles C. Thomas, Springfield, 1973; pp 143–60.

  7. Sehgal A, Tran H, Carse E. Doppler manifestations of ductal steal- role in decision making-. Eur J Pediatr. 2010;170:795–8.

    Article  Google Scholar 

  8. Keusters L, Purna J, Deshpande P, Mertens L, Shah P, McNamara PJ, et al. Clinical validity of systemic arterial steal among extremely preterm infants with persistent patent ductus arteriosus. J Perinatol. 2021;41:84–92.

    Article  Google Scholar 

  9. 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 

  10. 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 

  11. 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;63:89–94.

    Article  Google Scholar 

  12. 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  Google Scholar 

  13. Serwer GA, Armstrong BE, Anderson PAW. Non-invasive detection of retrograde descending aortic flow in infants using continuous wave Doppler ultrasonography. J Pediatr. 1980;97:394–400.

    Article  CAS  Google Scholar 

  14. Badr KF, Ichikawa I. Prerenal failure: a deleterious shift from renal compensation to decompensation. N Engl J Med. 1988;319:623–9.

    Article  CAS  Google Scholar 

  15. Koralkar R, Ambalavanan N, Levitan EB, McGwin G, Goldstein S, Askenazi D. Acute kidney injury reduces survival in very low birth weight infants. Pediatr Res. 2011;69:354–8.

    Article  Google Scholar 

  16. Jetton JG, Askenazi DJ. Update on acute kidney injury in the neonate. Curr Opin Pediatr. 2012;24:191–6.

    Article  CAS  Google Scholar 

  17. Armstrong DL, Teele RL, Kuschel CA, Harding JE. The use of renal Doppler ultrasonography to diagnose patent ductus arteriosus in preterm infants. J Ultrasound Med. 2001;20:1005–10.

    Article  CAS  Google Scholar 

  18. 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 Pediat.r 2020;216:95–102.

    Google Scholar 

  19. 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  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Monash Newborn, Monash Children’s Hospital, Melbourne, VIC, Australia

    Arvind Sehgal, Brendan Mulcahy & Pramod Pharande

  2. Department of Paediatrics, Monash University, Melbourne, VIC, Australia

    Arvind Sehgal, Pramod Pharande & Suraj Varma

  3. Monash Heart, Monash Health, Clayton, Melbourne, VIC, Australia

    Suraj Varma

Authors
  1. Arvind Sehgal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brendan Mulcahy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pramod Pharande
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Suraj Varma
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AS: Conception and design of the work, image acquisition, analysis/interpretation of data, and writing of the first draft of the manuscript. BM: Important contribution to the manuscript draft revision and clinical/biochemical data collection. PP: Image acquisition, study design, and critical contribution to draft manuscript. SV: Image interpretation and analysis with important contribution to manuscript preparation. All authors approved the final version and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Arvind Sehgal.

Ethics declarations

Competing interests

The authors declare no competing interests.

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

Sehgal, A., Mulcahy, B., Pharande, P. et al. The often forgotten systemic effects of ductus arteriosus: impact on decision-making and future trials. J Perinatol 41, 2363–2366 (2021). https://doi.org/10.1038/s41372-021-01163-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-021-01163-x

Search

Advanced search

Quick links