Weng Jianbin,Shi Xucong,Shen Zhipeng.Research advances on the association between brain injury and patent ductus arteriosus in preterm infants[J].Journal of Clinical Pediatric Surgery,2026,(08):792-795.[doi:10.3760/cma.j.cn101785-20260412-00176]
动脉导管未闭与早产儿脑损伤关联性研究进展
- Title:
- Research advances on the association between brain injury and patent ductus arteriosus in preterm infants
- Keywords:
- Patent Ductus Arteriosus; Infant; Premature; Brain Injuries; Neurodevelopmental Disorders; Intervention
- 摘要:
- 早产儿脑损伤是导致远期神经发育障碍的主要原因，动脉导管未闭（patent ductus arteriosus,PDA）引起的血流动力学改变在其中起重要作用。本文系统阐述PDA通过体循环“窃血”、心功能障碍及脑血流自动调节受损等机制诱发脑损伤的病理过程，量化其临床特征对早产儿脑发育的影响，并探讨现有干预策略（保守治疗、药物治疗、手术治疗）在脑保护方面的共识与争议，为制定改善早产儿脑发育结局的个体化管理方案提供参考。
- Abstract:
- Brain injury has been recognized as a major cause of long-term neurodevelopmental impairment and hemodynamic changes due to patent ductus arteriosus (PDA) play an important role in preterms.This review systematically discussed the pathological pathways of PDA inducing brain injury through such mechanisms as systemic “steal” phenomenon,cardiac dysfunction and impaired cerebral blood flow autoregulation.It examined the characteristics of PDA and its quantitative impact on brain development in preterm infants and explained the controversies and consensus regarding existing intervention strategies (conservative management,pharmacotherapy & surgical ligation) in terms of cerebral protection.It was intended to provide references for individualizing clinical management strategies to improve neurodevelopmental outcomes in preterm infants.
参考文献/References:
[1] Ybarra M,Miller SP.Advances in preterm brain injury[J].Pediatr Clin North Am,2025,72(5):919-937.DOI:10.1016/j.pcl.2025.05.009.
[2] Zhou MC,Wang SP,Zhang T,et al.Neurodevelopmental outcomes in preterm or low birth weight infants with germinal matrix-intraventricular hemorrhage:a meta-analysis[J].Pediatr Res,2024,95(3):625-633.DOI:10.1038/s41390-023-02877-8.
[3] Cao Y,Jiang SY,Sun JH,et al.Assessment of neonatal intensive care unit practices,morbidity,and mortality among very preterm infants in China[J].JAMA Netw Open,2021,4(8):e2118904.DOI:10.1001/jamanetworkopen.2021.18904.
[4] 洪菲，张敏，韩树萍，等.胎龄<32周早产儿脑室周围－脑室内出血进展的危险因素分析[J].临床小儿外科杂志，2025,24(8):745-751.DOI:10.3760/cma.j.cn101785-202406010-008.Hong F,Zhang M,Han SP,et al.Analysis of risk factors for progression of periventricular-intraventricular hemorrhage in preterm infants with gestational age <32 weeks[J].J Clin Ped Sur,2025,24(8):745-751.DOI:10.3760/cma.j.cn101785-2024 06010-008.
[5] Chock VY,Bhombal S,Variane GFT,et al.Ductus arteriosus and the preterm brain[J].Arch Dis Child Fetal Neonatal Ed,2023,108(2):96-101.DOI:10.1136/archdischild-2022-324111.
[6] Imanishi T,Sumiya W,Kanno C,et al.Relationship of cerebral blood volume with arterial and venous flow velocities in extremely low-birth-weight infants[J].Eur J Pediatr,2023,182(6):2821-2832.DOI:10.1007/s00431-023-04969-3.
[7] Sortica da Costa C,Cardim D,Molnar Z,et al.Changes in hemodynamics,cerebral oxygenation and cerebrovascular reactivity during the early transitional circulation in preterm infants[J].Pediatr Res,2019,86(2):247-253.DOI:10.1038/s41390-019-0410-z.
[8] Kratimenos P,Sanidas G,Simonti G,et al.The shifting landscape of the preterm brain[J].Neuron,2025,113(13):2042-2064.DOI:10.1016/j.neuron.2025.03.024.
[9] Martini S,Czosnyka M,Smielewski P,et al.Clinical determinants of cerebrovascular reactivity in very preterm infants during the transitional period[J].Pediatr Res,2022,92(1):135-141.DOI:10.1038/s41390-022-02090-z.
[10] Lemmers PMA,Benders MJNL,D’Ascenzo R,et al.Patent ductus arteriosus and brain volume[J].Pediatrics,2016,137(4):e20153090.DOI:10.1542/peds.2015-3090.
[11] Tsao PC.Pathogenesis and prevention of intraventricular hemorrhage in preterm infants[J].J Korean Neurosurg Soc,2023,66(3):228-238.DOI:10.3340/jkns.2022.0288.
[12] Apeksha Reddy P,Sreenivasulu H,Shokrolahi M,et al.Navigating the complexities of intraventricular hemorrhage in preterm infants:an updated review[J].Cureus,2023,15(5):e38985.DOI:10.7759/cureus.38985.
[13] Lemmers P,Vijlbrief D,Benders M,et al.Delayed surgical closure of the patent ductus arteriosus:does the brain pay the price?[J].J Pediatr,2023,254:25-32.DOI:10.1016/j.jpeds.2022.10.010.
[14] Dix L,Molenschot M,Breur J,et al.Cerebral oxygenation and echocardiographic parameters in preterm neonates with a patent ductus arteriosus:an observational study[J].Arch Dis Child Fetal Neonatal Ed,2016,101(6):F520-F526.DOI:10.1136/archdischild-2015-309192.
[15] Ybarra M,Selvanathan T,Guo T,et al.Hemodynamic risk factors for cerebellar hemorrhage presence and volume in infants born very preterm[J].J Pediatr,2025,280:114503.DOI:10.1016/j.jpeds.2025.114503.
[16] Schreiner C,Sappler M,H?ck M,et al.Brain injury and microstructural brain development in very preterm infants with patent ductus arteriosus[J].Neonatology,2026,123(1):28-35.DOI:10.1159/000548673.
[17] Ambalavanan N,Aucott SW,Salavitabar A,et al.Patent ductus arteriosus in preterm infants[J].Pediatrics,2025,155(5):e2025071425.DOI:10.1542/peds.2025-071425.
[18] Wei YJ,Lin YC,Chen YJ,et al.Blood flow assessment in echocardiography of hemodynamically significant patent ductus arteriosus in preterm infants[J].Pediatr Res,2026,99(4):1517-1522.DOI:10.1038/s41390-025-04449-4.
[19] Mifflin J,Makoni M,Chatmethakul T,et al.Cerebral and intestinal Doppler patterns according to patent ductus arteriosus shunt characteristics in preterm infants[J].J Perinatol,2026,46(3):349-357.DOI:10.1038/s41372-025-02505-9.
[20] Navikiene J,Virsilas E,Vankeviciene R,et al.Brain and renal oxygenation measured by NIRS related to patent ductus arteriosus in preterm infants:a prospective observational study[J].BMC Pediatr,2021,21(1):559.DOI:10.1186/s12887-021-03036-w.
[21] Variane GFT,Chock VY,Netto A,et al.Simultaneous near-infrared spectroscopy (NIRS) and amplitude-integrated electroencephalography (aEEG):dual use of brain monitoring techniques improves our understanding of physiology[J].Front Pediatr,2020,7:560.DOI:10.3389/fped.2019.00560.
[22] 施旭聪，翁建彬，李建华.早产儿动脉导管未闭手术治疗新进展[J].临床小儿外科杂志，2022,21(4):390-393.DOI:10.3760/cma.J.cn101785-202009019-018.Shi XC,Weng JB,Li JH.Recent surgical advances for patent ductus arteriosus in premature infants[J].J Clin Ped Sur,2022,21(4):390-393.DOI:10.3760/cma.J.cn101785-202009019-018.
[23] Laughon MM,Thomas SM,Watterberg KL,et al.Expectant management vs medication for patent ductus arteriosus in preterm infants:the PDA randomized clinical trial[J].JAMA,2026,335(7):588-599.DOI:10.1001/jama.2025.23330.
[24] Schmidt B,Davis P,Moddemann D,et al.Long-term effects of indomethacin prophylaxis in extremely-low-birth-weight infants[J].N Engl J Med,2001,344(26):1966-1972.DOI:10.1056/NEJM200106283442602.
[25] Zuckerman SL,Mirro R,Armstead WM,et al.Indomethacin reduces ischemia-induced alteration of blood-brain barrier transport in piglets[J].Am J Physiol,1994,266(6 Pt 2):H2198-H2203.DOI:10.1152/ajpheart.1994.266.6.H2198.
[26] Mitra S,Scrivens A,Fiander M,et al.Early treatment versus expectant management of hemodynamically significant patent ductus arteriosus for preterm infants[J].Cochrane Database Syst Rev,2025,2025(6):CD013278.DOI:10.1002/14651858.CD0132 78.pub3.
[27] Kidokoro H,Anderson PJ,Doyle LW,et al.Brain injury and altered brain growth in preterm infants:predictors and prognosis[J].Pediatrics,2014,134(2):e444-e453.DOI:10.1542/peds.2013-2336.
[28] Weisz DE,Mirea L,Rosenberg E,et al.Association of patent ductus arteriosus ligation with death or neurodevelopmental impairment among extremely preterm infants[J].JAMA Pediatr,2017,171(5):443-449.DOI:10.1001/jamapediatrics.2016.5143.
[29] Rodriguez Ogando A,Planelles Asensio I,de la Blanca ARS,et al.Surgical ligation versus percutaneous closure of patent ductus arteriosus in very low-weight preterm infants:which are the real benefits of the percutaneous approach?[J].Pediatr Cardiol,2018,39(2):398-410.DOI:10.1007/s00246-017-1768-5.
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备注/Memo
收稿日期:2026-4-12。
通讯作者:沈志鹏,Email:shenzp@zju.edu.cn