Patent ductus arteriosus and brain volume

Background and Objectives: A hemodynamically significant patent ductus arteriosus (PDA) can compromise perfusion and oxygenation of the preterm brain. Reports suggest that PDA is associated with increased mortality and morbidity. We hypothesize that long-standing low cerebral oxygenation due to PDA might affect brain volume at term equivalent age. Methods: Observational study in 140 infants investigating the relationship between nearinfrared spectroscopy-monitored cerebral oxygen saturation (rScO2) and MRI-assessed regional brain volume and maturation of the posterior limb of the internal capsule at termequivalent age in 3 groups: those whose PDA closed with indomethacin, those who needed additional surgical closure, and matched controls. Results: The surgery group had the lowest rScO2 values before closure (n = 35), 48% ± 9.7% (mean ± SD) as compared with the indomethacin (n = 35), 59% ± 10.4 (P <.001), and control groups (n = 70), 66% ± 6.9 (P <.001); the highest postnatal age before effective treatment; and the lowest volumes of most brain regions at term-equivalent age. Multiple linear regression analysis showed a significant effect of preductal closure rScO2 on cerebellar volume in this group. No differences were found in maturation of the posterior limb of the internal capsule. Conclusions: Long-standing suboptimal cerebral oxygenation due to a PDA may negatively influence brain growth, affecting neurodevelopmental outcome.