Bedside PDA ligation in premature infants less than 28 weeks and 1000 grams
Mustafa Kemal Avsar1, Tolga Demir2, Cem Celiksular3
1Medicana International Istanbul Hospital Department of Cardiovascular Surgery, Istanbul, Turkey. mustafakemalavsar@hotmail.com.
Insights
Bedside surgical closure of patent ductus arteriosus (PDA) is a safe and effective procedure for very-low-birth-weight premature neonates (VLBWPN). This study confirms its safety in VLBWPN with significant PDA, leading to successful outcomes.
Area of Science:
- Neonatal Surgery
- Pediatric Cardiology
- Critical Care Medicine
Background:
- Patent ductus arteriosus (PDA) is a common condition in premature infants, leading to significant hemodynamic and respiratory issues.
- High incidence (70%) of PDA in infants born before 28 weeks gestation; spontaneous closure rate is low (34%) in very-low-birth-weight premature neonates (VLBWPN).
- Medical management of PDA has debated efficacy and duration; bedside surgical ligation offers a safe alternative.
Purpose of the Study:
- To retrospectively evaluate the safety and outcomes of bedside PDA ligation in VLBWPN.
- To assess the feasibility of surgical PDA closure in extremely premature infants.
- To present data on a cohort of VLBWPN undergoing bedside PDA ligation.
Main Methods:
- Retrospective study of 26 VLBWPN (born <28 weeks gestation, <1000g) who underwent bedside PDA ligation between 2012 and 2015.
- All patients received initial medical treatment with indomethacin; 6 cases discontinued due to adverse effects.
- Data collected on patient demographics, treatment, surgical outcomes, and post-discharge follow-up.
Main Results:
- No surgical mortality was observed.
- One case of late pneumothorax occurred as a surgical complication.
- Five patients (19%) were lost to follow-up, with sepsis being the most common cause of mortality (3 cases).
- Twenty-one patients were discharged between 86-238 days; common post-discharge issue was chronic lung problems.
- Follow-up ranged from 2 months to 3 years.
Conclusions:
- Bedside PDA ligation in the ICU is a safe and effective surgical method for VLBWPN with clinically significant PDA.
- The procedure demonstrates low morbidity and mortality in this vulnerable population.
- Further research can explore long-term outcomes and optimize perioperative care.
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.
