G147 Outcome of surgical ligation of the patent ductus arteriosus in premature babies –a national prospective study

Abstract

AimsWith many conflicting studies it is not surprising that management of the patent ductus arteriosus (PDA) in the preterm infant remains controversial. Ibrahim et al1 advocate early surgical closure of symptomatic PDA to facilitate extubation and establish enteral feeding. Small retrospective studies such as this are unlikely to influence UK practice and assist in the development criteria for babies requiring surgical PDA ligation. This study aimed to describe the epidemiology and outcome of premature infants undergoing surgical PDA ligation.MethodsA UK wide prospective study was conducted between 1st September 2012 and 30th September 2013 through the British Paediatric Surveillance Unit (BPSU). Paediatric consultants were asked to report babies born less than 37 weeks gestation who underwent surgical PDA ligation prior to hospital discharge. Following notification a detailed questionnaire was sent to consultants.ResultsOver 13 months, 531 notifications were received, 68 cases were reported in error. 58 questionnaires were not returned. After merging duplicate questionnaires, 267 infants requiring surgical PDA ligation were identified. 161 (60%) were male, median birth gestation was 28 (range 22+5–34+4) weeks and median birth weight 740 (range 421–3460) grams. Median age of ligation was 33 (range 7–576) days and weight 1020 (range 500–4000) g. Indications for PDA ligation are shown in Figure 1. For England and Wales, the overall incidence of surgical PDA ligation was 35/100,000 live rising to 13/100 live births at 24 weeks gestation. Medical treatment commonly with Ibuprofen was administered in 154 (64%) infants prior to ligation. Open surgical ligation was the preferred method used in 240(97%) of the babies and trans-catheter occlusion in 7. Most procedures 164(68%) were performed in cardio-thoracic theatre. Post ligation complications occurred in 51(20%) cases: pneumothorax (45%) was commonest. Overall there were 17 (6.3%) deaths – none in the immediate peri-operative period.ConclusionThis is the largest prospective UK survey of surgical PDA ligation in premature infants. Surgical ligation is most commonly performed in extremely low birthweight and premature infants with excellent survival. Further work is required to determine the criteria for and timing of surgical PDA ligation.Abstract G147 Figure 1Indication for PDA ligation

Early echocardiography does not predict subsequent treatment of symptomatic patent ductus arteriosus in extremely preterm infants

“…In contrast, our patients were only treated if they had a persistent PDA (affecting the respiratory and cardiovascular systems with ibuprofen and surgical ligation if refractory to two courses of ibuprofen or if the gastrointestinal or renal systems were involved), with medical treatment at about 12 days of age or surgical treatment at about five weeks of life. The strategy and timing of treatment of the duct in our study is very similar to recently conducted national BPSU survey and is representative of practice in the United Kingdom . With this moderately delayed, selective treatment of symptomatic PDA, early echocardiography performed in the first 72 hours of age did not predict the subsequent need for treatment.…”