738 - Correlations between Hemodynamically Significant Patent Ductus Arteriosus and Near Infrared Spectroscopy in Extremely Premature Neonates: A Single-Center Study

Publication Number: 2720.738

Claire B. Vietri, Seattle Children's, Seattle, WA, United States; Amisha Tarkunde, OHSU/University of Washington School of Medicine, Portland, OR, United States; Madison Pelton, University of Washington School of Medicine, Seattle, WA, United States; Rishabh Jain, University of Washington, Seattle, WA, United States; Kendell German, University of Washington School of Medicine, Seattle, WA, United States; Ulrike Mietzsch, University of Washington School of Medicine/ Seattle Children's Hospital, Seattle, WA, United States; Thomas Wood, University of Washington, Seattle, WA, United States; matthew Studer, University of Washington School of Medicine, Seattle, WA, United States; Sarah Kolnik, University of Washington - Seattle Children's Hospital, Seattle, WA, United States

Background: Infants with hemodynamically significant patent ductus arteriosus (hsPDA) have shown decreased regional cerebral tissue oxygen saturation (rScO2) due to presumed shunting of systemic blood back to the lungs. Very extreme preterm (VEP) infants born between 22 0/7 to 24 6/7 weeks of gestation are at risk of impaired cerebral blood flow (CBF) in the first 72 hours after birth due to impaired autoregulation and transition to extrauterine life. hsPDA potential effects on CBF in VEP infants is not well-described.

Objective: Characterize how rScO2 changes in VEP infants with hsPDA stratified by echocardiographic criteria (Echo-hsPDA) and clinical treatment (Tx-HsPDA).

Design/Methods: Observational study of VEP infants born from 2022-24 who received continuous rScO2 monitoring in the first 72 hours. hsPDA echocardiogram (Echo-hsPDA) criteria included: qualitative and measured size of the PDA, PDA peak velocity, PDA shunt direction, left ventricular end-diastolic dimension z-score, LA/Ao ratio, left pulmonary artery end-diastolic velocity, retrograde aortic diastolic flow, or treatment (Tx-hsPDA) with medication only or surgery (percutaneous closure after medication). We used linear mixed model analysis to generate reference curves of rScO2 in first 72 hours after birth stratified by Echo-hsPDA criteria (0, 1, or ≥ 2) and PDA treatment (none, medical, surgical). Pearson variables network was used to examine the correlation between rScO2 and Echo-hsPDA criteria, and a heat map to examine associations between variables.

Results: In the 24 infants in this study there was no difference in demographic variables when categorized by number of Echo-hsPDA criteria (Table 1). Infants with Echo-hsPDA ≥ 1 criteria compared to infants without had overall lower trend rScO2 trajectories than those without. In infants with ≥ 2 Echo-hsPDA criteria, rScO2 trajectories did not increase in 24-48 hours compared to those with ≤ 1 Echo-hsPDA (Fig 1a). Infants with surgical Tx-PDA had lower rScO2 trajectories compared to no treatment or medical Tx-PDA (Fig 1b). rScO2 values were most negatively associated with LA/Ao ratio and qualitatively assessed large PDA (Fig 2a). Ostium size was positively associated with surgery (Fig 2b).

Conclusion(s): In VEP infants early rScO2 trajectories showed lower trends in those who later met Echo-hsPDA criteria. Those with ≥ 2 criteria did not have an increase in rScO2 at 24 hours. Lower rScO2 trends correlated with infants who later had percutaneous closure. Early rScO2 screening with use of precise VEP-specific echocardiographic criteria may help identify those with hsPDA at risk for altered CBF.

Table 1. Maternal, Perinatal, and Neonatal Demographics stratified by Echocardiographic Criteria for HsPDA
1n (%); Median [Q1, Q3]

2Fisher's exact test; Kruskal-Wallis rank sum test

Relationship between NIRS (rScO2) and variables in HsPDA
Figure 1: LOESS rScO2 curves a. Echocardiogram Criteria HsPDA: rScO2 trajectories between 6 to 72 hours after birth stratified by echocardiogram criteria for hsPDA, (0-1, or ≥ 2), adjusting for gestational age, CRIB II, and head circumference. b. Clinical Management HsPDA: rScO2 trajectories between 6 to 72 hours after birth stratified by clinical management of hsPDA (none, medical, and surgical) adjusting for gestational age, CRIB II, and head circumference.

Figure 2: Relationship between NIRS (rScO2) and variables in HsPDA.
Figure 2: Relationship between NIRS (rScO2) and variables in hsPDA. 2a. Pearson Variable Graphical Analysis showing the relationship between NIRS (rScO2) and criteria of hsPDA, including: LVIDd z-score (Left Ventricular Internal Dimension at end-Diastole z-score); Large PDA, Surgical Treatment, LA/Ao Ratio, Left Atrium Diameter by Aorta Diameter Ratio); LPA End Diastolic Velocity, (Left Pulmonary Artery at End Diastolic Velocity); PDA Peak Velocity, Bidirectional PDA Flow (compared to those with left to right flow, no infants with only right to left flow), Ostium Size PDA, Retrograde Aortic Diastolic Flow. The purple lines indicate a negative association. The gold indicates a positive association. The thickness of the line corresponds to the absolute value and strength of r. b: Heat Map Relating NIRS (rScO2) and Components of the Echocardiogram. NIRS (rScO2), Surgical Treatment, Large PDA, LVIDd z-score, retrograde Aortic Diastolic Flow, Ostium Size of PDA, Bidirectional PDA Flow, PDA Peak Velocity, LPA End Diastolic Velocity, and LA/Ao Ratio, to one another. The two axes represent the variables compared, and the value of the Pearson's coefficient in each cell determines the color. Blue represents a positive relationship, while red represents a negative relationship.