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Cerebral blood volume changes during closure by surgery of patent ductus arteriosus

¹ Department of Paediatrics, Essen University Hospital, Essen, Germany
² German Paediatric Heart Centre, Department of Pediatric Thoracic and Cardiovascular Surgery, St Augustin, Germany
³ Vest Children’s Hospital, Department of Neonatology and Paediatric Intensive Care, University of Witten/Herdecke, Datteln, Germany

Correspondence to:
Dr C Roll, Vestische Kinder-und Jugendklinik, Dr-Friedrich-Steiner-Str 5, D-45711 Datteln, Germany; claudia.roll{at}kinderklinik-datteln.de

Background: Surgical closure of a patent ductus arteriosus (PDA) in very low birth weight (VLBW) infants has been associated with impaired neurodevelopmental outcome. Surgical PDA closure may result in abrupt changes of cerebral haemodynamics.

Objective: To examine the cerebral blood volume changes occurring after surgical closure of PDA.

Design: Continuous cerebral near-infrared spectroscopy (NIRS) recording throughout PDA surgery.

Setting: Tertiary neonatal intensive care unit, with PDA surgery performed on the ward.

Patients: Ten VLBW infants, median birth weight 748 g (range 590–1070), gestational age 24 (23–27) weeks, chronological age 14 (12–22) days.

Intervention: Surgical closure of PDA.

Main outcome measures: Changes in cerebral oxygenated haemoglobin, cerebral deoxygenated haemoglobin, and tissue oxygenation index (measured), changes in cerebral blood volume (CBV) and cerebral haemoglobin difference (calculated) as measured by NIRS.

Results: During the first 2 minutes after closure of the PDA, CBV increased significantly (mean (SD) 0.14 (0.12) ml/100 g tissue; p = 0.01) and returned to baseline within 2–5 minutes. Cerebral oxygenation did not change.

Conclusions: There is a short-lasting increase in CBV immediately after surgical closure of PDA, but no change in cerebral oxygenation. These transient changes are unlikely to cause harm.