scholarly journals Age at Surgical Ligation of Patent Ductus Arteriosus Affects Prognosis in Extremely Premature Infants

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Qiuping Li ◽  
Tao Han ◽  
Yonghui Yang ◽  
Gengxu Zhou ◽  
Hui Wang ◽  
...  
Keyword(s):  
Birth Weight ◽  
Patent Ductus Arteriosus ◽  
Premature Infants ◽  
Enteral Feeding ◽  
Gestational Age ◽  
Ductus Arteriosus ◽  
Surgical Ligation ◽  
Gestational Age At Birth ◽  
Age At Birth ◽  
Patent Ductus

Background: This study aimed to evaluate outcomes, prognosis, and safety associated with the timing of surgical ligation for patent ductus arteriosus (PDA) in extremely premature infants (EPI). Methods: We reviewed the clinical data of 44 EPI (gestational age at birth 26.8 ± 0.67 weeks; birth weight 997 ± 152 g) who received surgical ligation for hemodynamically significant PDA (hsPDA) in the Neonatal Intensive Care Unit (NICU) of Bayi Children’s Hospital in China between January 2021 and December 2014. We compared the general characteristics, underlying diseases, postoperative surgical complications, and prognoses in two groups of patients who received early ligation (≤ 14 days after birth) and late ligation (> 14 days after birth). Results: The gender, gestational age at birth, birth weight, Apgar score, postoperative surgical complications, rates of bronchopulmonary dysplasia (BPD), retinopathy of prematurity, necrotic enterocolitis, periventricular leukomalacia, total hospitalization, and medical costs of both groups were compared. According to the results, the late ligation group had a higher rate of severe BPD (66.3% cf. 35%) and required significantly longer time to reach total enteral feeding and weaning of respiratory support compared with the early ligation group. Conclusions: In EPI with hsPDA, for whom medical treatment failed or is contraindicated, early surgical closure of the ductus arteriosus can promote earlier total enteral feeding, shorten the duration of mechanical ventilation, and reduce the rates of severe BPD.

Efficiency and Safety of Patent Ductus Arteriosus Surgical Ligation in Extremely Low Birth Weight Infants Without Chest Tube Placement

2021 ◽  
Author(s):  
Georgios Kourelis ◽  
Meletios Kanakis ◽  
Constantinos Loukas ◽  
Felicia Kakava ◽  
Konstantinos Kyriakoulis ◽  
...  
Keyword(s):  
Birth Weight ◽  
Patent Ductus Arteriosus ◽  
Chest Tube ◽  
Ductus Arteriosus ◽  
Extremely Low Birth Weight ◽  
Tube Placement ◽  
Chest Tube Placement ◽  
Surgical Ligation ◽  
Patent Ductus

AbstractPatent ductus arteriosus (PDA) has been associated with increased morbidity and mortality in preterm infants. Surgical ligation (SL) is generally performed in symptomatic infants when medical management is contraindicated or has failed. We retrospectively reviewed our institution's experience in surgical management of PDA for extremely low birth weight (ELBW) infants without chest tube placement assessing its efficiency and safety. We evaluated 17 consecutive ELBW infants undergoing SL for symptomatic PDA (January 2012–January 2018) with subsequent follow-up for 6 months postdischarge. Patients consisted of 9 (53%) females and 8 (47%) males. Mean gestational age (GA) at birth was 27.9 ± 2.1 weeks. Median values for surgical age (SA) from birth to operation was 10 days (interquartile range [IQR]: 8–12); PDA diameter 3.4 mm (IQR: 3.2–3.5); surgical weight (SW) 750 g (IQR: 680–850); and days of mechanical ventilation (DMV) as estimated by Kaplan–Meier curve 22 days (95% confidence interval: 14.2–29.8). We observed a statistically significant negative association between DMV and GA at birth (rho = − 0.587, p = 0.017), SA (rho = − 0.629, p = 0.009) and SW (rho = − 0.737, p = 0.001). One patient experienced left laryngeal nerve palsy confirmed by laryngoscopy. Otherwise, there were no adverse events to include surgical-related mortality, recurrence of PDA, or need for chest tube placement during follow-up. SL of PDA in ELBW infants without chest tube placement is both efficient and safe. Universal consensus recommendations for the management of PDA in ELBW neonates are needed. Further study is required regarding the use of the less invasive option of percutaneous PDA closure in ELBW infants.

scholarly journals Ligation of patent ductus arteriosus in very low birth weight premature infants

2020 ◽  
Vol 61 (4) ◽  
pp. 399-405
Author(s):  
Hasan F. Othman ◽  
Debra T. Linfield ◽  
Mohamed A. Mohamed ◽  
Hany Aly
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Patent Ductus Arteriosus ◽  
Premature Infants ◽  
Very Low Birth Weight ◽  
Ductus Arteriosus ◽  
Patent Ductus

Nonsurgical Management of Persistent and Hemodynamically Significant Patent Ductus Arteriosus among Extremely Low Birth Weight Infants: A Propensity Score Matched Analysis

2017 ◽  
Vol 35 (08) ◽  
pp. 729-736
Author(s):  
Kalsang Dolma ◽  
Michael Zayek ◽  
Lynn Batten ◽  
Keith Peevy ◽  
Fabien Eyal ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Patent Ductus Arteriosus ◽  
Surgical Approach ◽  
Ductus Arteriosus ◽  
Extremely Low Birth Weight ◽  
Surgical Ligation ◽  
Nonsurgical Management ◽  
Approach Group ◽  
Patent Ductus

Objective The objective of this study was to evaluate the impact of a nonsurgical approach (with the incorporation of late postnatal hydrocortisone treatment to facilitate extubation) in comparison to the surgical approach for the management of persistent hemodynamically significant patent ductus arteriosus (hsPDA) among chronically ventilator-dependent extremely low birth weight (ELBW) infants. Methods In this retrospective study, ELBW infants with a diagnosis of hsPDA (diagnosed based on the echocardiographic criteria and chronic ventilator dependence) that were persistent beyond 14 days of postnatal age despite adequate medical treatment were included. Results Out of 127 infants (surgical approach group, n = 67 and nonsurgical approach group, n = 60), 72 infants were matched based on the propensity scores. In the matched cohort, in comparison to infants managed with the surgical approach (control group, n = 36), infants in the nonsurgical approach group (treatment group, n = 36) had a lower rate of surgical ligation (14 vs. 100%, p = < 0.001), but there were no differences in both primary outcome (death or bronchopulmonary dysplasia) and secondary outcome measures. Conclusion For chronically ventilator-dependent ELBW infants with persistent hsPDA, a nonsurgical management approach is associated with a reduced rate of surgical ligation of PDA, but not associated with increased risk of adverse major short-term neonatal outcomes.

scholarly journals SAFETY AND QUALITY OF INTRAVENOUS LIPIDS FOR NEWBORNS: EFFECTS ON CRITICAL DISEASES AND METABOLIC DISORDERS (PART II)

2021 ◽  
Vol 11 (4(42)) ◽  
pp. 68-74
Author(s):  
I. Anikin ◽  
V. Snisar
Keyword(s):  
Birth Weight ◽  
Patent Ductus Arteriosus ◽  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Metabolic Disorders ◽  
Ductus Arteriosus ◽  
Lipid Emulsions ◽  
Intravenous Lipids ◽  
Patent Ductus

Premature birth and its complications cause stress in newborns, which restrains their physical growth for several weeks after birth and is associated with chronic morbidity and neurological disability in the future. Preterm infants face such difficulties as respiratory distress, cardiovascular disease, gastrointestinal dysfunction and very low birth weight. Most complications in newborns are associated with oxidative stress that develops during the early period of growth. The formation of free radicals entails oxidative damage to many organs and systems of the body and is the main factor responsible for the development of typical diseases of preterm infants, such as bronchopulmonary dysplasia, patent ductus arteriosus, retinopathy of prematurity, necrotizing enterocolitis, intraventricular hemorrhage, and respiratory distress syndrome. Premature infants depend on adequate early parenteral nutrition, which not only guarantees they will survive but also ensures positive health outcomes later in life. Early use of intravenous lipids helps to prevent essential fatty acid deficiencies, provides energy and substrates for cell membrane synthesis, which are important for the growth and development of infants with very low and extremely low birth weight. This publication represents data on the effect of intravenous lipids on critical conditions and metabolic disorders in newborns. Literature sources are analyzed and the existing evidence of the possible influence of lipid emulsions on critical diseases in newborns is presented: intraventricular hemorrhage; necrotizing enterocolitis, patent ductus arteriosus and thrombocytopenia; glucose metabolism (hypo- and hyperglycemia); hyperbilirubinemia and chronic liver damage. The literature review is aimed at finding optimal strategies for the use of lipid emulsions in intensive care of newborns to improve the quality of care for premature infants. The purpose of this work is to analyze the results of published studies and systematize data on the feasibility and safety of lipid emulsions used in newborns with critical diseases of the perinatal period.

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