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Risk factors associated with prolonged mechanical ventilation after surgical patent ductus arteriosus ligation in
Yu Mi Seo1, In Kyung Sung1, Sook Kyung Yum1
1Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Insights
Preterm infants needing prolonged mechanical ventilation after patent ductus arteriosus (PDA) ligation often have severe respiratory illness. Peak respiratory severity score (RSS)/kg before surgery is a key predictor of needing extended ventilation post-PDA ligation.
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Respiratory Medicine
Background:
- Hemodynamically significant patent ductus arteriosus (hsPDA) can cause pulmonary over-circulation, but PDA treatment outcomes vary.
- The impact of PDA ligation on pulmonary outcomes, particularly the need for prolonged mechanical ventilation, requires further investigation.
Purpose of the Study:
- To identify clinical characteristics, specifically respiratory parameters, associated with prolonged mechanical ventilation after PDA ligation in preterm infants.
- To evaluate the predictive value of respiratory illness severity scores in determining the need for extended mechanical ventilation post-PDA ligation.
Main Methods:
- A retrospective study included preterm infants (≤32 weeks gestation) who underwent PDA ligation.
- Infants were categorized based on extubation status: ≤14 days (successful extubation) or >14 days (prolonged mechanical ventilation).
- Clinical data, including respiratory severity scores (RSS) and PDA size, were compared between groups.
Main Results:
- Of 172 preterm infants, 36 (20.9%) had PDA ligation; 21 (58.3%) required prolonged mechanical ventilation (>14 days).
- Infants needing prolonged ventilation were smaller (gestational age, birth weight) and had higher preoperative respiratory severity (HFOV, RSS/kg) and larger PDA size.
- Multivariable analysis identified peak preoperative RSS/kg as the sole significant predictor of prolonged mechanical ventilation (p=0.012, OR=0.207).
Conclusions:
- Preterm infants with compromised respiratory status pre-PDA ligation are at higher risk for prolonged mechanical ventilation.
- Respiratory status assessment in the early neonatal period is crucial for managing hsPDA treatment effects.
- Identifying infants at risk can refine treatment strategies for hsPDA, aiming for improved pulmonary outcomes.
Background:
One of the main pathophysiologies of a hemodynamically significant patent ductus arteriosus (hsPDA) involves pulmonary over-circulation. However, PDA treatment does not present with uniform effects on pulmonary outcomes. We aimed to evaluate the clinical characteristics - in particular, respiratory parameters - associated with prolonged mechanical ventilation after PDA ligation.
Methods:
Preterm infants ≤32 weeks gestation were included in the study. Infants who underwent PDA ligation were grouped depending on whether the infant successfully was extubated ≤14 d after ligation or required prolonged invasive mechanical ventilation >14 d after ligation. The clinical characteristics, including the parameters concerning the respiratory illness severity and hemodynamical significance of PDA shunt, were compared between the two groups.
Results:
Among 172 preterm infants, 36 (20.9%) infants underwent surgical PDA ligation. Fifteen (41.6%) infants were successfully extubated at ≤14 d after ligation, and 21 (58.3%) infants required prolonged invasive mechanical ventilation for >14 d after ligation. In the univariable analysis, the infants who required prolonged mechanical ventilation was significantly smaller in terms of gestational age (GA) and birth weight and tended to present a greater respiratory illness severity [represented by the use of high-frequency oscillatory ventilation (HFOV) and greater RSS (respiratory severity score)/kg] with a larger PDA size prior to PDA ligation. In the multivariable logistic regression analysis, peak preoperative RSS/kg (p = 0.012, OR = 0.207, 95% CI = 0.060-0.706) was the only significant factor associated with prolonged mechanical ventilation after PDA ligation.
Conclusion:
Preterm infants with the compromised respiratory condition may be prone to prolonged mechanical ventilation after PDA ligation. The respiratory status during the early phase of life should be considered when evaluating the effect of PDA treatment. With an extended view, distinguishing infants with such risk factors may lead to more polished treatment strategies toward hsPDA.
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