Brain injury and microstructural brain development in very preterm infants with patent ductus arteriosus

Introduction: Evidence regarding the association between patent ductus arteriosus (PDA) and brain development in very preterm infants is inconclusive. The aim of the current study was to systematically evaluate brain injury and microstructural brain maturation as assessed by magnetic resonance imaging (MRI) at term-equivalent age in a contemporary cohort of very preterm infants with and without PDA. Methods: This was a retrospective, single-centre study. Preterm infants born at <32 weeks’ gestation with PDA and cerebral MRI were eligible for this study. They were matched 1:1 according to gestational age (GA) to infants without PDA. MRI was assessed for brain injury. We measured fractional anisotropy and apparent diffusion coefficient in 12 brain regions as indicators for microstructural brain maturation. Results: We included 148 infants with PDA and 148 matched controls. We found no significant differences in brain injury rates between the groups. The evaluation of microstructural brain maturation revealed differences in some regions. After adjusting for differences in neonatal characteristics, a significant difference was seen only in the right middle cerebellar peduncle. Among infants with PDA, those who underwent surgical ligation exhibited elevated rates of both, cerebellar hemorrhage and severe IVH, and further showed a more immature brain maturation pattern. Statistical difference was lost for all variables after adjusting for GA. Conclusion: Our results indicate that the presence of PDA is not intrinsically associated with brain injury or impaired brain development.