title: Bedside PDA ligation in premature infants less than 28 weeks and 1000 grams.
abstract: BACKGROUND
  PDA(Patent ductus arteriosus) is a common and clinically important condition which is presented with a number of hemodynamic and respiratory problems such as intraventricular hemorrhage, pulmonary hemorrhage and necrotizing enterocolitis due to increased pulmonary blood flow and stealing from systemic circulation. The incidence of PDA among the infants that were born before the 28th gestational week is as high as 70 %; and spontaneous closure rates in very-low-birth-weight premature neonates(VLBWPN) is around 34 %. The onset, duration, and repeat number of consecutive courses of the prostaglandin synthesis inhibitor medication for PDA closure are still issues of debate. Bed-side PDA closure is a safe surgical procedure in both mature and premature babies. Here we aim to retrospectively present our 26 cases which were less than 28 weeks and 1000 grams that underwent bed-side PDA ligation.
  
  
  METHODS
  This retrospective study included 26 VLBWPN with PDA that underwent bed-side ligation between 2012 and 2015. Babies were born before the 28th gestational week (23-27 weeks) and less than 1000 grams (489-970 gr). Of the 26, 15 were female and 11 were male. Indomethacin was administered to all of the cases as the medical closing agent. The medication was stopped due to unwanted effects in 6 cases. All of the patients took medical treatment before surgery.
  
  
  RESULTS
  No surgical mortality occurred during our study. One case of pneumothorax was recorded as late surgical complication. Five of the 26 patients were lost, and the most common cause of mortality was sepsis (in 3 cases). The remaining 21 cases were discharged on days 86-238. The follow-up periods of the patients were 2 moths - 3 years. The most frequent problems encountered after discharge was chronic lung problems.
  
  
  CONCLUSIONS
  Bed side PDA ligation surgery in the ICU is a safe method for VLBWPN with clinically significant PDA.
authors.affiliation: Medicana International Istanbul Hospital Department of Cardiovascular Surgery, Istanbul, Turkey. mustafakemalavsar@hotmail.com.
authors.forename: Mustafa Kemal
authors.initials: MK
authors.lastname: Avsar
authors.affiliation: Kolan International Hospital Department of Cardiovascular Surgery, Istanbul, Turkey.
authors.forename: Tolga
authors.initials: T
authors.lastname: Demir
authors.affiliation: Medicana International Istanbul Hospital Depratment of Anesthesiology, Istanbul, Turkey.
authors.forename: Cem
authors.initials: C
authors.lastname: Celiksular
authors.affiliation: Medicana International Istanbul Hospital Department of Pediatric Cardiology, Istanbul, Turkey.
authors.forename: Cenap
authors.initials: C
authors.lastname: Zeybek
mesh_terms: D002317:Cardiovascular Agents / Q000627:therapeutic use; D004374:Ductus Arteriosus, Patent / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008026:Ligation; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*
chemical_list: D002317:Cardiovascular Agents; D007213:Indomethacin
keywords: Bedside surgery; Patent ductus arteriosus; Premature infant