Hemodynamic evaluation following ductal closure and association with IVH in premature infants born at 22–23weeks gestation

Background Intraventricular hemorrhage (IVH) remains a major complication in extremely preterm infants, but the immediate hemodynamic changes associated with hemorrhage after ductal closure are not well defined. Methods This was a two-center retrospective cohort study conducted at two tertiary neonatal intensive care units. Hemodynamic parameters, including left ventricular diastolic diameter, mean velocity of circumferential fiber shortening, end-systolic wall stress, mean arterial pressure, heart rate, and internal cerebral vein waveform grade, were assessed serially from birth to 72 h of life. Generalized linear mixed-effects models were used to evaluate temporal associations between post-closure hemodynamic changes and IVH. Results In this two-center retrospective cohort study, 26 infants born at 22–23 weeks’ gestation were included. Seven infants developed grade 2–4 IVH, all first detected after PDA closure, while 19 who did not IVH. Infants who developed IVH showed a distinct post-closure pattern characterized by increased end-systolic wall stress, mean arterial pressure, and heart rate, together with reduced mean velocity of circumferential fiber shortening, within 12 h after ductal closure. Between-group differences were significant at 6 and 12 h after closure (all p < 0.01). Conclusion Hemodynamic instability emerging within 12 h after ductal closure was associated with subsequent IVH in infants born at 22–23 weeks’ gestation. These findings identify the immediate post-closure period as a critical window for circulatory monitoring and potential targeted intervention.