Neurodevelopment Outcomes and Cardiac Output Changes following Patent Ductus Arteriosus Ligation in Preterm Infants

Objective: Infants receiving PDA ligations are at risk for subsequent neurodevelopmental impairment. We had conducted a prospective study to monitor cardiac output (CO) changes in preterm infants undergoing surgical ligation for patent ductus arteriosus (PDA) and found a significant decline in CO following the surgery. Because CO is positively correlated with cerebral blood flow, we speculated that the degree of CO changes was associated with neurodevelopmental outcome. In this study, we aimed to correlate post-ligation CO changes with later neurodevelopment outcome.

Methods: Based on previous study, CO were monitored at pre-surgery, 1-minute following ligation, and 1, 6, 12, 18, 24, 48 hours after ligation, and were compared to pre-surgery baseline. We enrolled infants with Bayley III evaluation at 1-year corrected age. Developmental impairment was defined as Bayley III

Results: After excluding 2 infants with intraventricular hemorrhage grade ≥3, 2 expired before discharge, 1 lost follow-up, 25 infants who had Bayley III score at 1-year corrected age were enrolled and 14 (56%) of them had developmental impairment. Their gestational age, birth weight, age at ligation and ductal diameter were 28.1±1.8 (mean±SD) weeks, 981±268 gm, 14.4±7.5 days and 2.7±0.9 mm, respectively.

Infants who had developmental impairment had a significant CO decline immediately following ligation (-18.7% vs. 3.7%, p=0.041), and a trend of generally more decreased CO was also seen in this group (repeated measured ANOVA between-group p=0.103). No difference in demographics, echocardiographic features or blood pressure were observed between the two groups.

Conclusion: An immediate decline of CO following PDA ligation was associated with developmental impairment at 1-year corrected age in preterm infants. However, future prospective study is warranted to clarify the association between PDA ligation, CO changes, and afterward neurodevelopment outcome.