title: Outcomes of neonatal patent ductus arteriosus ligation in Canadian neonatal units with and without pediatric cardiac surgery programs.
abstract: OBJECTIVE
  Preterm infants needing patent ductus arteriosus (PDA) ligation are transferred to a pediatric cardiac center (CC) unless the operation can be done locally by a pediatric surgeon at a non-cardiac center (NCC). We compared infant outcomes after PDA ligation at CC and NCC.
  
  
  METHODS
  We analyzed 990 preterm infants who had PDA ligation between 2005 and 2009 using the Canadian Neonatal Network database. In-hospital mortality and major morbidities were compared between CC (n=18) and NCC (n=9).
  
  
  RESULTS
  SNAP-II-adjusted mortality rates were similar (CC=8.7% vs NCC=10.7%, P=.32). Significant cranial ultrasound abnormalities (CC=24.1% vs NCC=32.1%, P<.01) and culture-proven sepsis (CC=39.7% vs NCC=54.8%, P<.01) were more frequent in infants treated at NCC. Infants transferred to CC had higher rates of cranial ultrasound abnormalities (transferred 31.6% vs non-transferred 20.4%, P<.01). NSAIDs prior to PDA ligation were used more often at NCC (CC 36.6% vs NCC 75.6%, P<.001).
  
  
  CONCLUSIONS
  Mortality rates after PDA ligation were similar at CC and NCC, but cranial ultrasound abnormalities and sepsis rates were higher at NCC. Higher morbidity may be associated with different PDA management strategies, including NSAID use or infant transfer. Further studies are needed to investigate the reasons for these differences in morbidity.
authors.affiliation: McMaster Pediatric Surgery Research Collaborative, Hamilton ON, Canada.
authors.forename: Charles
authors.initials: C
authors.lastname: Wong
authors.forename: Michael
authors.initials: M
authors.lastname: Mak
authors.forename: Sandesh
authors.initials: S
authors.lastname: Shivananda
authors.forename: Junmin
authors.initials: J
authors.lastname: Yang
authors.forename: Prakeshkumar S
authors.initials: PS
authors.lastname: Shah
authors.forename: Wendy
authors.initials: W
authors.lastname: Seidlitz
authors.forename: Julia
authors.initials: J
authors.lastname: Pemberton
authors.forename: Peter G
authors.initials: PG
authors.lastname: Fitzgerald
authors.forename: Brian H
authors.initials: BH
authors.lastname: Cameron
mesh_terms: D000015:Abnormalities, Multiple / Q000453:epidemiology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001927:Brain Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D002170:Canada; D016507:Cardiology Service, Hospital / Q000458:organization & administration; D003131:Combined Modality Therapy; D016208:Databases, Factual; D004374:Ductus Arteriosus, Patent / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D005260:Female; D006748:Hospital Departments / Q000458:organization & administration*; D017052:Hospital Mortality; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000401:mortality / Q000601:surgery*; D007236:Infant, Small for Gestational Age; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008026:Ligation; D008297:Male; D010360:Patient Transfer / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000458:organization & administration; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology; D012720:Severity of Illness Index; D013503:Surgery Department, Hospital / Q000458:organization & administration; D062606:Tertiary Care Centers / Q000458:organization & administration / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal