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Changing patterns of patent ductus arteriosus surgical ligation in the United States
Jeff Reese1, Theresa A Scott1, Stephen W Patrick2
1Mildred T. Stahlman Division of Neonatology, Vanderbilt University Medical Center, 11111 Doctor's Office Tower, 2200 Children's Way, Nashville 37232-9544, TN.
Insights
Surgical ligation for patent ductus arteriosus (PDA) in infants has decreased, with ligated infants being smaller and more complex. Despite increased vocal cord paralysis, mortality rates improved, suggesting better care for this critical congenital heart defect.
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Congenital Heart Disease
Background:
- Optimal management for patent ductus arteriosus (PDA) remains debated.
- Surgical ligation, a common treatment, is linked to adverse outcomes in neonates.
Purpose of the Study:
- To analyze trends in PDA ligation rates over time and geography.
- To assess the impact of PDA ligation on surgical complication rates.
- To evaluate changes in infant characteristics and outcomes associated with PDA ligation.
Main Methods:
- Retrospective analysis of the Kids' Inpatient Database (2000-2012).
- Inclusion criteria: infants weighing <1500g birth weight.
- Data analysis focused on ligation rates, infant demographics, comorbidities, and surgical outcomes.
Main Results:
- PDA ligation rates decreased from 87.4 to 58.8 per 1000 hospital births between 2006 and 2012.
- Infants undergoing ligation were smaller (<1000g) and had higher rates of necrotizing enterocolitis, bronchopulmonary dysplasia, and intraventricular hemorrhage.
- Ligation-associated vocal cord paralysis increased (1.2% to 3.9%), but overall mortality decreased (12.4% to 6.5%).
Conclusions:
- PDA ligation has become less frequent but is performed on smaller, more medically complex infants.
- Despite an increase in specific complications like vocal cord paralysis, improved survival suggests advances in neonatal and surgical care.
- Geographical variations in ligation rates persist, warranting further investigation.
Abstract:
Optimal management of patent ductus arteriosus (PDA) is unclear. One treatment, surgical ligation, is associated with adverse outcomes. We reviewed data from the Kids' Inpatient Database (2000-2012) to determine if PDA ligation rates: (1) changed over time, (2) varied geographically, or (3) influenced surgical complication rates. In 2012, 47,900 infants <1500g birth weight were born in the United States, including 2,800 undergoing PDA ligation (5.9%). Ligation was more likely in infants <1000g (85.9% vs. 46.2%), and associated with necrotizing enterocolitis (59.2% vs. 37.5%), BPD (54.6% vs. 15.2%), severe intraventricular hemorrhage (16.4% vs. 5.3%), and hospital transfer (37.6% vs. 16.4%). Ligation rates peaked in 2006 at 87.4 per 1000 hospital births, dropping to 58.8 in 2012, and were consistently higher in Western states. Infants undergoing ligation were more likely to experience comorbidities. Rates of ligation-associated vocal cord paralysis increased over time (1.2-3.9%); however, mortality decreased (12.4-6.5%). Thus, PDA ligation has become less frequent, although infants being ligated are smaller and more medically complex. Despite increase in some complications, mortality rates improved perhaps reflecting advances in care.
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