The optimal timing of surgical ligation of patent ductus arteriosus in preterm or very-low-birth-weight infants

Of 36 very low birth weight infants (<1,500 gm) with large patent ductus arteriosus, 24 (67%) showed satisfactory constriction or closure after indomethacin therapy (mean total dose 0.4 mg/kg). Twelve infants (33%) responded inadequately with seven infants requiring surgical ligation. Response was better in infants 8 to 14 days old compared to those more than 14 days old (89% vs 33%, P = .048) irrespective of birth weight or gestational age. Major complications were renal and unrelated to ductus response. Urine output fell significantly (3.65 to 1.63 ml/kg/hr, P < .001) and in 47% of infants serum creatinine increased ≥1.5 mg/dl. Creatinine was less likely to rise in infants more than 14 days old. Hyponatremia was found in 36% of infants. Serum potassium increased more frequently in infants more than 8 days old and was >6.0 mEq/liter in 25%. Indomethacin caused a reduction in PaCO2 (41 to 37 mm Hg, P < .01) and an increase in pH (7.32 to 7.36, P < .02) with no change in base deficit. These changes occurred even in the absence of clinical ductus closure. No other side effects of indomethacin therapy were noted. Three infants died but death was unrelated to indomethacin therapy. Overall survival was 92%, and nine infants (25%) developed mild bronchopulmonary dysplasia.

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Surgical ligation of patent ductus arteriosus in very low birth weight infants: A 9-year single center experience

10.21203/rs.3.rs-17138/v1 ◽

2020 ◽

Author(s):

Jun Ho Lee ◽

Hyun Ju Lee ◽

Hyun-Kyung Park ◽

Ja-Hye Ahn ◽

Hee Sun Kim ◽

...

Keyword(s):

Birth Weight ◽

Surgical Treatment ◽

Low Birth Weight ◽

Patent Ductus Arteriosus ◽

Neonatal Intensive Care ◽

Very Low Birth Weight ◽

Ductus Arteriosus ◽

Low Birth Weight Infants ◽

Surgical Ligation ◽

Patent Ductus

Abstract Background We analyzed the feasibility and outcomes of early surgical ligation in very low birth weight infants (VLBWIs) with hemodynamically significant patent ductus arteriosus (HSPDA) and investigated predictors for surgical treatment after unsuccessful medical management. Methods Medical records from the neonatal intensive care unit of Hanyang University Seoul Hospital from January 2010 to December 2018 were retrospectively reviewed. 233 VLBWIs with HSPDA were enrolled in our study. Of these infants, 134 underwent surgical ligation and were subdivided into the early ligation group (n = 49; within 10 days of age) and the late ligation group (n = 85; after 10 days of age). Results The mean gestational age and birth weight were significantly lower in the patent ductus arteriosus (PDA) ligation group than in the Non-ligation group (p < 0.001). PDA ductal diameter > 2.0 mm (p < 0.001), low Apgar score at 5 minutes (p = 0.033), and chorioamnionitis (p = 0.037) were the predictors for receiving surgical treatment for PDA. Early ligation was significantly associated with a low incidence of culture-proven sepsis (p = 0.004), mechanical ventilator time > 4 weeks (p = 0.007), necrotizing enterocolitis stage (NEC) ≥ III (p = 0.022), and intraventricular hemorrhage (IVH) grade ≥ III (p = 0.035). Conclusions Early surgical ligation minimizes adverse effects of HSPDA in predicted infants who subsequently require surgical treatment for PDA. We suggest that predicted VLBWIs with HSPDA that is unresponsive to medical treatment should avoid delayed ductal closure to reduce severe NEC, severe IVH, culture-proven sepsis, and facilitate earlier endotracheal extubation.

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