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Radiographic Characterization of Rib Structural Deformity Following Surgical Patent Ductus Arteriosus Clipping in
Naoto Nishizaki1, Michimasa Suzuki2, Nao Kikuchi2
1Pediatrics, Juntendo University Urayasu Hospital, Chiba, JPN.
Insights
Patent ductus arteriosus (PDA) ligation in preterm infants can cause rib deformities, especially in those not given NSAIDs pre-surgery. Retinopathy of prematurity also correlates with these structural changes.
Area of Science:
- Neonatal surgery
- Pediatric radiology
- Thoracic surgery
Background:
- Patent ductus arteriosus (PDA) ligation is a common procedure in preterm infants.
- The impact of PDA ligation on rib structural integrity remains unclear.
- This study investigates rib deformities post-PDA ligation in preterm neonates.
Purpose of the Study:
- To analyze radiographically evident rib deformity in preterm infants following PDA ligation.
- To identify factors associated with rib structural modifications after PDA ligation.
Main Methods:
- Retrospective observational study of preterm infants (<37 weeks gestation) undergoing PDA ligation.
- Left posterolateral thoracotomy approach used for PDA ligation.
- Two blinded radiologists evaluated serial chest radiographs before and after surgery.
Main Results:
- Six of 28 eligible preterm infants showed post-ligation rib deformity, affecting ribs 3-6.
- Rib deformity cohort had lower preoperative NSAID use (P=0.04) and higher incidence of retinopathy of prematurity requiring intervention (P<0.01).
- Younger corrected gestational age at surgery trended with rib deformities (P=0.05).
Conclusions:
- Rib structural deformity is common in preterm infants not receiving NSAIDs before PDA ligation.
- Retinopathy of prematurity is associated with increased risk of rib deformity post-PDA ligation.
- Younger corrected gestational age at surgery is a potential risk factor for rib deformities.
Background:
The effect of patent ductus arteriosus (PDA) ligation through clipping on rib structural integrity in preterm infants is not yet fully elucidated. This study aimed to analyze radiographically evident rib deformity in preterm infants following PDA ligation and identify factors associated with these modifications.
Methods:
This retrospective observational study enrolled preterm infants (gestational age <37 weeks) who underwent PDA ligation through left posterolateral thoracotomy between January 2014 and December 2022. Two radiologists, blinded to the clinical data, independently evaluated serial plain chest radiographs obtained before and after the surgical intervention.
Results:
Of the 46 preterm infants with PDA requiring surgical ligation, 28 met the inclusion criteria. Six patients exhibited radiographic rib deformity following the procedure (rib alteration cohort), whereas 22 exhibited no such changes (control cohort). The structural modifications predominantly affected the left third through sixth ribs. Although no significant intergroup differences were observed in gestational age, birthweight, sex, antenatal corticosteroid administration, cumulative nonsteroidal anti-inflammatory drug (NSAID) doses, chronological age at surgery, operative duration, or incidence of postoperative complications, the rib deformity cohort demonstrated significantly lower utilization of preoperative NSAIDs (P = 0.04) and significantly higher prevalence of retinopathy of prematurity requiring intervention at discharge (P < 0.01). In addition, the corrected gestational age at surgical intervention tended to be younger in the cohort with rib deformities than in controls (P = 0.05).
Conclusion:
Rib structural deformity represents a common phenomenon in preterm infants who did not receive NSAIDs before PDA ligation and those with retinopathy of prematurity. Furthermore, these modifications tended to occur in infants with a younger corrected gestational age at the time of surgical intervention.
