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Extremely low birth weight infants with patent ductus arteriosus: searching for the least invasiveness
Mehmet Oc1, Bora Farsak, Bahar Oc
1Department of Cardiovascular Surgery, Selcuk University, Konya, Turkey. mehmetoc@hotmail.com
Insights
Surgical closure of patent ductus arteriosus (PDA) in extremely low birth weight infants (ELBWI) is safe and effective. This minimally invasive approach avoids chest tubes, simplifying care and reducing costs for fragile newborns.
Area of Science:
- Neonatal Surgery
- Pediatric Cardiology
Background:
- Patent ductus arteriosus (PDA) poses significant risks to extremely low birth weight infants (ELBWI).
- Standard treatments like indomethacin may fail or be contraindicated in these fragile neonates.
- Minimally invasive surgical options are crucial due to the high surgical stress vulnerability of ELBWI.
Purpose of the Study:
- To evaluate the safety and efficacy of a minimally invasive surgical technique for PDA closure in ELBWI.
- To assess the outcomes of a specific surgical approach involving muscle-sparing thoracotomy, PDA clipping without ligation, and no chest tube drainage.
Main Methods:
- Surgical closure of PDA in 26 ELBWI who failed or had contraindications for indomethacin.
- Posterior muscle-sparing thoracotomy.
- PDA clipping without ligation, followed by thoracic closure without tube thoracostomy.
Main Results:
- No surgery-related mortality or morbidity observed in the 26 treated ELBWI.
- Mean gestational age at birth: 27 weeks; mean birth weight: 960.96 g.
- Mean age at operation: 18.06 days; mean body weight at operation: 989.42 g.
Conclusions:
- Minimally invasive surgical closure of PDA without chest tube drainage is safe and feasible in premature infants.
- The described surgical technique potentially reduces long-term physical impairment and simplifies postoperative care.
- This approach may lead to reduced healthcare costs and fewer required postoperative chest X-rays.
Abstract:
Patent ductus arteriosus (PDA) is an important problem in premature infants. Extremely low birth weight infants (ELBWI) are so fragile with respect to surgical stress that minimally invasive procedures are required. We report 26 ELBWI cases with PDA who underwent surgical closure. All had failed indomethacin treatment, or it had been contraindicated. The mean gestational age at birth was 27 weeks (range, 24-38 weeks), and the mean birth weight was 960.96 g (range, 710-1440 g). The mean age at operation was 18.06 days (range, 7-34 days), and the mean body weight at operation was 989.42 g (range, 680-1460 g). There was no surgery-related mortality or morbidity. Our surgical procedures consisted of posterior muscle-sparing thoracotomy, clipping the PDA and no ligation, and closing the thorax without a tube thoracostomy. Muscle-sparing thoracotomy reduces the likelihood of long-term physical impairment and deformity, the clipping technique minimizes the dissection of surrounding PDA tissue, and the thorax is closed without a tube. Nursing care is simplified, costs are reduced, and the number of chest x-rays needed postoperatively is reduced. We believe that surgical closure of PDA without chest tube drainage can be accomplished safely in premature infants.
