Patent ductus arteriosus (PDA) staging and splanchnic circulation in high risk preterm infants

Abstract

Objective: To evaluate the influence of PDA on superior mesenteric artery (SMA) and celiac artery (CA) in the immediate postnatal period in preterm infants. Methods: 50 preterm less than 32week with birth weight less than 1kg was included in the prospective observation study. PDA (PSV: peak systolic velocity, EDV: end diastolic velocity, TAV: time average velocity). Blood flow indices (resistive index; RI, pulsatility index; PI) was calculated. PDA was categorized as small, moderate and large. Values taken at 48hr were considered for statistical calculation. Result: Significant PDA was associated with high SMA PSV and low EDV in both SMA and CA. Large (n=12) and moderate PDA (n=3) was associated with high PSV and low EDV in SMA, hence was associated with significantly high RI (large; 0.85±0.04, moderate; 0.80±0.03) in mesenteric circulation. In celiac circulation, large PDA was associated with low EDV (11.66±6.09) and moderate PDA was associated with significant high PSV (64.33±13.05). This velocity pattern in CA was associated with significant high RI (0.77±0.08) and high PI (1.73±0.52) in large PDA group. Velocities in small PDA and no PDA groups were comparable in both arteries. Conclusion: Significant PDA was associated with attenuated blood velocities in SMA compromising the intestinal perfusion. Celiac artery blood flow velocities were adversely affected by large PDA. Low EDV is the predicting factor for compromised perfusion in both the arteries. PDA diameter and flow in descending aorta was the determining factor.