Acute hemodynamic decompensation following patent ductus arteriosus ligation in premature infants.
BACKGROUND
Patent ductus arteriosus (PDA) ligation can lead to postoperative hemodynamic instability requiring inotropic support, termed hemodynamic decompensation. The purpose of this study was to prospectively determine the incidence, predictors, and clinical impact of hemodynamic decompensation after PDA ligation in preterm infants.


METHODS
All infants undergoing PDA ligation were eligible for this prospective cohort study. After undergoing ligation, patients were followed until 30 days after successful extubation, discharge from the NICU, or death. Data collection included perinatal and preoperative clinical information, operative details, postoperative course, and outcome.


RESULTS
Ninety-six preterm infants were enrolled and underwent PDA ligation. Hemodynamic decompensation occurred in 27 patients (28%). Overall in-hospital mortality rate was 18%. Mortality was significantly higher among infants that developed hemodynamic decompensation (33% vs 11%, p = .012). Hemodynamic decompensation was associated with an adjusted odds ratio (OR) for death of 3.1 (95% confidence interval: 1.0-9.5, p = .05). Lower estimated gestational age, lower corrected age, and higher rate of preoperative mechanical ventilation were significant predictors of hemodynamic decompensation.


CONCLUSIONS
Hemodynamic decompensation occurred in 28% of patients after PDA ligation, resulting in a significantly higher mortality. Younger patients requiring higher ventilator support are most likely to develop hemodynamic decompensation.
Harting
Matthew T
MT
University of Texas Medical School at Houston, Houston, TX, USA.
Blakely
Martin L
ML
Cox
Charles S
CS
Lantin-Hermoso
Regina
R
Andrassy
Richard J
RJ
Lally
Kevin P
KP
D004374:Ductus Arteriosus, Patent / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008026:Ligation / Q000009:adverse effects; D008297:Male; D011446:Prospective Studies; D012121:Respiration, Artificial