461 - Impact of Transcatheter Patent Ductus Arteriosus Closure on Cerebral Blood Flow in Preterm Infants: A Pilot Study Using Frequency-Domain Near-Infrared Spectroscopy and Diffuse Correlation Spectroscopy

Publication Number: 3446.461

Wievineke Apers, Amalia Children's Hospital, Nijmegen, Gelderland, Netherlands; Sutin Jason, Boston Children's Hospital, Boston, MA, United States; Elena Dominguez-Villasenor, Boston Children's Hospital, Boston, MA, United States; German Figueroa, Boston Children's Hospital, Somerville, MA, United States; P. Ellen grant, Boston Children's Hospital, Boston, MA, United States; Willem de Boode, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands, Nijmegen, Gelderland, Netherlands; Philip T. Levy, Boston Children's Hospital, BROOKLINE, MA, United States; Michael Farias, Boston Children's Hospital, Boston, MA, United States; Pei-Yi Lin, Boston Children's Hospital, Cambridge, MA, United States;

Background: There has been rapid adoption of transcatheter device occlusion of the hemodynamically significant patent ductus arteriosus (PDA) in premature infants over the past decade. While cerebral oxygen saturation has been examined with near-infrared spectroscopy (NIRS) during surgical ligation of the PDA, cerebral blood flow (CBF) has not been investigated during transcatheter device occlusion in premature infants. Frequency-domain near-infrared spectroscopy and diffuse correlation spectroscopy (FDNIRS-DCS) are a novel approach to quantity changes in cerebral blood flow.

Objective: In this pilot study we aimed to determine the feasibility of monitoring CBF with FDNIRS-DCS during PDA closure and describe changes in CBF before, during, and after device PDA occlusion in premature infants.

Design/Methods: We performed a prospective, observational study of infants born before 37 weeks gestational age (GA) who underwent transcatheter device PDA occlusion at Boston Children’s Hospital before 3 months’ corrected age. An FDNIRS-DCS sensor was attached to patient’s forehead for continuously monitoring cerebral blood flow index (CBFi) during transcatheter closure. Factors influencing CBFi were collected, including ventilation settings, pCO2, administered medications, heart rate variability, PDA characteristics on echocardiography prior to the procedure, and common neonatal comorbidities. This was an observational study with descriptive analysis only.

Results: Seven participants were included in this study. CBFi increased in all participants during deployment of the device and attenuation of the PDA. CBFi was highest directly after device placement and remained elevated during post-procedural evaluations. The measurement did not interfere with the transcatheter closure, and no adverse outcomes associated with the FDNIRS-DCS measurement were reported for any participant.

Conclusion(s): This pilot study demonstrates feasibility of continuously monitoring CBFi with FDNIRS-DCS during transcatheter device occlusion of the PDA. There was rapid and persistent elevation of CBFi during device closure. Future studies will focus on linking these changes to meaningful short- and long- term outcomes.