Short-term outcomes of patent ductus arteriosus ligation in preterm neonates: reason for concern?
We evaluated outcomes of preterm infants following surgical ligation of patent ductus arteriosus (PDA). We performed a retrospective chart review. Our cohort (N = 82) had a median (range) gestational age of 25.5 (23 to 28) weeks and birth weight of 765 (484 to 1150) g. Ligation was the initial intervention in the primary group (N = 28) and was performed after failed medical therapy in the secondary group (N = 54). At 48 hours following ligation, an increase in fraction of inspired oxygen (FiO(2)) and ventilatory and pressor support were observed in 49 (60%), 35 (43%), and 15 (18%) infants, respectively. The median (range) duration to return to preoperative FiO(2) was 3 (1 to 30) days and extubation was 16 (1 to 98) days. Rates of bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage, necrotizing enterocolitis, and retinopathy were 42.7%, 32.9%, 19.6%, and 11%, respectively. Outcomes did not differ between primary and secondary ligation groups, nor between early (<or=4 weeks, N = 52) and late ligation (>4 weeks old, N = 30). A lower gestation was significantly associated with postoperative deterioration and BPD. Preterm infants undergoing PDA ligation often experience a postoperative deterioration and have an extremely high incidence of comorbidities. Whether the ductus itself or the "therapeutic" ligation is causally linked to these adverse outcomes remains to be determined.
Natarajan
Girija
G
Department of Pediatrics, Division of Neonatal Perinatal Medicine, Children's Hospital of Michigan, Detroit, Michigan 48201, USA. gnatara@med.wayne.edu
Chawla
Sanjay
S
Aggarwal
Sanjeev
S
D004374:Ductus Arteriosus, Patent / Q000601:surgery*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008026:Ligation; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome