Consequences of Delayed Surgical Closure of Patent Ductus Arteriosus in Very Premature Infants

Jaillard, Sophie; Larrue, Benoît; Rakza, Thameur; Magnenant, Eric; Warembourg, H; Storme, Laurent

doi:10.1016/j.athoracsur.2005.03.141

Cited by 57 publications

(53 citation statements)

References 15 publications

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“…The ages of our subjects ranged between 2 and 71 (39.9±18.1) days and were compatible with late-term operation according to the criteria accepted in the references. While some studies defended that there was no relation between timing of surgical operation and clinical course, in other studies better results were obtained with the first early intervention in cases where indication was acceptable (1,3,8). Although four of five subjects who were weaned from mechanic ventilation in the first three days in our study group were 25 days old or younger, no statistically significant relation was found with the subjects who were operated in a later period.…”

Section: Discussioncontrasting

confidence: 43%

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Günübirlik cerrahi girişim ile patent duktus arteriyozusu bağlanan 20 düşük ağırlıklı erken doğmuş bebekte cerrahi tedavi ve ameliyat sonrası izlem sonuçları

Vuran¹,

Ayabakan²,

Yörüker³

et al. 2011

tpa

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S Su ur rg gi ic ca al l a an nd d p po os st to op pe er ra at ti iv ve e f fo ol ll lo ow w--u up p r re es su ul lt ts s f fo or r d da ay y c ca as se e l li ig ga at ti io on n o of f p pa at te en nt t d du uc ct tu us s a ar rt te er ri io os su us s i in n 2 20 0 l lo ow w w we ei ig gh ht t p pr re em ma at tu ur re e p pa at ti ie en nt ts s C Ca an n V Vu ur ra an n, , C Ca an na an n A Ay ya ab ba ak ka an n, , U Uy yg ga ar r Y Yö ör rü ük ke er r, , E Em mr re e Ö Öz zk ke er r, , B Bü ül le en nt t S Sa ar ri it ta afl fl, , Ç Ça a¤ ¤r r› › G Gü ün na ay yd d› ›n n, , A Ay yd da a T Tü ür rk kö öz z C Ce em m P Pa ak ke et tç çi i* *, , Ö Öz zl le em m S Sa ar r› ›s so oy y, , O O¤ ¤u uz z O Om ma ay y, , N N. . K Kü ür rfl fla at t T To ok ke el l, , R R› ›z za a T Tü ür rk kö öz z O Or ri ig gi in na al l A Ar rt ti ic cl le e S Su um mm ma ar ry y Aim: We aimed to evaluate premature babies who were referred to us for closure of patent ductus arteriosus (PDA) and who were then transferred back in the early postoperative period. Material and Method: 20 preterm babies from six centers underwent PDA closure in the operating room. After obtaining approval from the local ethics committee, the cases were evaluated retrospectively. The mean weight was 650-1850 (1248,6±398,3) grams. The distance to these centers was 5-50(23,4±20,29) kilometers and the mean travel time was 2,5-28(12,57±11,44) minutes. In statistical analysis; correlation analysis, t and Mann-Whitney U tests were used. Results: There was no surgical or early mortality. All patients were transferred back within 24 hours. In the first two weeks, 13 (65%) babies were successfully weaned from mechanical ventilation support. 3 (15%) babies were lost in the late term due to sepsis and intracranial bleeding. There was no morbidity and mortality except for the one patient who had pneumothorax. All other patients were sent back to their reference centers in the first 24 hours after surgery. Conclusions:As the technology of patient transport vehicles and instruments develops and the skills of the medical personnel improve, the cardiac centers have the opportunity to safely operate low birth weight babies followed up in other centers. (Turk Arch Ped 2011; 46: 117-21)

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Section: Discussioncontrasting

confidence: 43%

“…Early closure of symptomatic PDA decreases development of chronic lung disease, mechanical ventilation times, nutritional deficiency , frequency of NEC and ICB (7,8). In contrast to the defenders of early closure of symptomatic PDA, there are also studies reporting that early closure does not affect clinical outcomes (9,10).…”

Section: Introductionmentioning

confidence: 97%

Günübirlik cerrahi girişim ile patent duktus arteriyozusu bağlanan 20 düşük ağırlıklı erken doğmuş bebekte cerrahi tedavi ve ameliyat sonrası izlem sonuçları

Vuran¹,

Ayabakan²,

Yörüker³

et al. 2011

tpa

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“…12,13 A number of studies have suggested early ligation to be beneficial with decreased rates of NEC 14 and improvements in growth. 15 The recent articles by Chorne et al 16 and Kabra et al 17 highlight associations between PDA ligation and increased risk of bronchopulmonary dysplasia, severe retinopathy of prematurity and neurosensory impairment. Whether PDA ligation is causal or is merely a surrogate marker of a biological state with an increased risk of chronic lung disease remains unknown.…”

Section: Discussionmentioning

confidence: 99%

Postoperative cardiorespiratory instability following ligation of the preterm ductus arteriosus is related to early need for intervention

et al. 2008

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Objective: To investigate the effect of postnatal age at patent ductus arteriosus (PDA) ligation on postoperative need for cardiotropic support.Study Design: A significant proportion of premature infants with a hemodynamically significant ductus arteriosus (HSDA) require surgical intervention. The relationship of postnatal maturation to postoperative cardiorespiratory stability is poorly understood. All preterm neonates who underwent PDA ligation between October 2002 and September 2004 were identified and divided according to postnatal age at ductal ligation, into early (p4 weeks, n ¼ 29) and late (>4 weeks, n ¼ 36) groups. Neonatal birth demographics and morbidities, characteristics of the HSDA and reason for ligation were reviewed. Indices of cardiorespiratory stability (for example heart rate, mean arterial pressure) were recorded before and 1, 4, 8, 12 and 24 h following ligation. Details of perioperative cardiovascular interventions (for example crystalloid boluses, cardiotropic agents) were recorded.Result: There were no differences in baseline neonatal demographics between the groups although a greater number of babies requiring early ligation had contraindication to indomethacin as the main reason for ligation. Early PDA ligation was associated with increased postoperative cardiotrope requirement (27.6 vs 5.6%, P ¼ 0.02) and decreased systolic blood pressure 8 h after intervention (P<0.05). Although increased oxygenation index was observed in both groups during the first 12 h it was only sustained to 24 h in the early group (P<0.05). Age at ligation remained a significant risk factor for postoperative cardiotrope requirement on multiple logistic regression analysis.Conclusion: Surgical ligation of the ductus arteriosus in preterm infants less than 28 days old is associated with oxygenation difficulties, decreased systolic arterial pressure and an increased need for cardiotropic support in the initial 24 postoperative hours. These data suggest the need to prospectively characterize perioperative cardiovascular physiology and identify predictive factors of clinical deterioration.

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“…21 The second concern with the watchful waiting approach is the delay in initiation of feeding and reaching full enteral feeds. 45 Although clear evidence is absent, because of the increased risk for NEC, many neonatologists do not start enteral feeds in the presence of a significant PDA. Finally, the longer one waits, the less effective the COX inhibitor becomes at closing the ductus arteriosus.…”

Section: Introductionmentioning

confidence: 99%

Patent ductus arteriosus in the preterm infant: to treat or not to treat?

Noori

2010

J Perinatol

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Pharmacological and/or surgical closure of a hemodynamically significant patent ductus arteriosus (PDA) in the very preterm infant has been the standard of care over the past few decades. However, the rationale for closure of PDA has recently been challenged. In this article, the factors that have fueled the controversy of the approach to the management of PDA and the gap in our knowledge are reviewed in detail. In addition, the pros and cons of the different treatment strategies applied in clinical care are evaluated with a focus on discussing the available evidence in the literature.

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Consequences of Delayed Surgical Closure of Patent Ductus Arteriosus in Very Premature Infants

Cited by 57 publications

References 15 publications

Günübirlik cerrahi girişim ile patent duktus arteriyozusu bağlanan 20 düşük ağırlıklı erken doğmuş bebekte cerrahi tedavi ve ameliyat sonrası izlem sonuçları

Günübirlik cerrahi girişim ile patent duktus arteriyozusu bağlanan 20 düşük ağırlıklı erken doğmuş bebekte cerrahi tedavi ve ameliyat sonrası izlem sonuçları

Postoperative cardiorespiratory instability following ligation of the preterm ductus arteriosus is related to early need for intervention

Patent ductus arteriosus in the preterm infant: to treat or not to treat?

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