Ligation of patent ductus arteriosus in low birth weight premature infants: timing for intervention and effectiveness of bed-side surgery

Metin, Kıvanç; Maltepe, Fikret; Kır, Mustafa; Bilen, Çağatay; Sökmen, Aslıhan; Oto, Öztekin; Uğurlu, Baran

doi:10.1186/1749-8090-7-129

Cited by 8 publications

(9 citation statements)

References 11 publications

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“…Low-birth-weight premature infants are usually intubated, their thermoregulation systems are sensitive, and they need numerous monitorization and intravenous infusion implementations. Thus to eliminate the possible risks of transportation, many advanced institutions now prefer bedside PDA ligation [ 4 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

Bedside PDA ligation in premature infants less than 28 weeks and 1000 grams

Avsar¹,

Demir²,

Celiksular³

et al. 2016

J Cardiothorac Surg

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BackgroundPDA(Patent ductus arteriosus) is a common and clinically important condition which is presented with a number of hemodynamic and respiratory problems such as intraventricular hemorrhage, pulmonary hemorrhage and necrotizing enterocolitis due to increased pulmonary blood flow and stealing from systemic circulation. The incidence of PDA among the infants that were born before the 28th gestational week is as high as 70 %; and spontaneous closure rates in very-low-birth-weight premature neonates(VLBWPN) is around 34 %. The onset, duration, and repeat number of consecutive courses of the prostaglandin synthesis inhibitor medication for PDA closure are still issues of debate. Bed-side PDA closure is a safe surgical procedure in both mature and premature babies. Here we aim to retrospectively present our 26 cases which were less than 28 weeks and 1000 grams that underwent bed-side PDA ligation.MethodsThis retrospective study included 26 VLBWPN with PDA that underwent bed-side ligation between 2012 and 2015. Babies were born before the 28th gestational week (23–27 weeks) and less than 1000 grams (489–970 gr). Of the 26, 15 were female and 11 were male. Indomethacin was administered to all of the cases as the medical closing agent. The medication was stopped due to unwanted effects in 6 cases. All of the patients took medical treatment before surgery.ResultsNo surgical mortality occurred during our study. One case of pneumothorax was recorded as late surgical complication. Five of the 26 patients were lost, and the most common cause of mortality was sepsis (in 3 cases). The remaining 21 cases were discharged on days 86–238. The follow-up periods of the patients were 2 moths - 3 years. The most frequent problems encountered after discharge was chronic lung problems.ConclusionsBed side PDA ligation surgery in the ICU is a safe method for VLBWPN with clinically significant PDA.

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Section: Introductionmentioning

confidence: 99%

Bedside PDA ligation in premature infants less than 28 weeks and 1000 grams

Avsar¹,

Demir²,

Celiksular³

et al. 2016

J Cardiothorac Surg

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“…The timing of PDA ligation in the referral center also depends on cost availability, which may contribute to some delay in surgical intervention, prolonging the persistence of an hsPDA. On the other hand, bedside PDA ligation has proved to be a safe and effective technique, with surgical outcomes comparable to operating room closure, low rates of postoperative infection, and reduced resource utilization [ 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Ductal ligation timing and neonatal outcomes: a 12-year bicentric comparison

et al. 2021

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Patent ductus arteriosus (PDA) is common among extremely preterm infants. In selected cases, surgical PDA ligation may be required. The timing for PDA ligation may depend upon a variety of factors, with potential clinical implications. We aimed to investigate the impact of different surgical PDA managements on ligation timing and neonatal outcomes. Inborn infants < 32 weeks of gestation and < 1500 g admitted at two tertiary Neonatal Intensive Care Units that underwent PDA ligation between 2007 and 2018 were enrolled in this retrospective cohort study and split into the following groups based on their surgical management: on-site bedside PDA ligation (ONS) vs. referral to an off-site pediatric cardiac surgery (OFS). Neonatal characteristics, surgical timing, and clinical outcomes of the enrolled infants were compared between the groups. Multivariate analysis was performed to evaluate the impact of PDA ligation timing on significantly different outcomes. Seventy-eight neonates (ONS, n = 39; OFS, n = 39) were included. Infants in the ONS group underwent PDA ligation significantly earlier than those in the OFS group (median age 12 vs. 36 days, p < 0.001) with no increase in postoperative mortality and complications. The multivariate analysis revealed a significant association between PDA ligation timing, late-onset sepsis prevalence (OR 1.045, 0.032), and oxygen need at discharge (OR 1.037, p = 0.025).Conclusions: Compared with off-site surgery, on-site bedside ligation allows an earlier surgical closure of PDA, with no apparent increase in mortality or complications. Earlier PDA ligation may contribute to reduced rates of late-onset sepsis and post-discharge home oxygen therapy, with possible cost-benefit implications. What is known:• Ineffective or contraindicated pharmacological closure of a hemodynamically significant PDA may require a surgical ligation.• Available literature comparing the effect of early vs. late PDA ligation on the main neonatal morbidities has yield contrasting results. What is new:• The availability of a cardiac surgery service performing bedside PDA ligation allows an earlier intervention compared to patient referral to an off-site center, with no difference in postoperative mortality and complications compared to off-site surgery.• Earlier PDA ligation was associated with a lower prevalence of late-onset sepsis and of oxygen need at discharge, with possible cost-benefit implications.

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“…Reopening may occur after indomethacin treatment, and it is more frequent in infants treated after the first week 13 . Given that the side effects of the drugs are more prominent in VLBW prematures, in some studies, advocated early surgical ligation may be a better approach 14–16 . Some studies have suggested that early surgical ligation of the PDA without medical treatment in VLBW prematures should be performed to reduce the complications of the PDA and medications 17,18 .…”

Section: Discussionmentioning

confidence: 99%

“…13 Given that the side effects of the drugs are more prominent in VLBW prematures, in some studies, advocated early surgical ligation may be a better approach. [14][15][16] Some studies have suggested that early surgical ligation of the PDA without medical treatment in VLBW prematures should be performed to reduce the complications of the PDA and medications. 17,18 Some studies suggested that early surgical ligation of the PDA without medical treatment in VLBW prematures should be performed to reduce the complications of the PDA and medications.…”

Section: Discussionmentioning

confidence: 99%

Bedside surgical ligation of the patent ductus arteriosus in very‐low‐birth‐weight premature infants: Limited upper ministernotomy as an alternative approach

Akyüz¹,

Işık²,

Mercan³

et al. 2020

J Card Surg

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Background: Patent ductus arteriosus (PDA) is an important cause of morbidity and mortality, especially in very-low-birth-weight infants. The aim of the present study was to evaluate the outcomes of bedside surgical ligation of PDA via limited upper ministernotomy as an alternative approach to thoracotomy. Materials and Methods: A total of 23 low-birth-weight premature infants, who underwent bedside ligation of PDA in the neonatal intensive care unit between January 2017 and April 2020, were enrolled. The patients were divided into two groups: those with thoracotomy (n = 13) and those with limited upper ministernotomy (n = 10). These patients were evaluated retrospectively in terms of clinical and preoperative, intraoperative, postoperative parameters between the groups. Results: Mean birth weight was 1059 ± 275 g in the thoracotomy group and 1035 ± 285 g in the ministernotomy group. There was no statistically significant difference in the age at surgery, weight at surgery, preoperative mechanical ventilation (MV) support, inotropic score onset of surgery, and total procedure time between the groups. There was a statistically significant difference in the hospital length of stay, postoperative MV time, and complications in the intensive care unit in favor of the ministernotomy group (p = .04, p = .03, p = .034, respectively). The study showed no statistically significant difference in the mortality rate between the two groups (two patients in the thoracotomy group and one patient in the ministernotomy group). Conclusion: The limited upper ministernotomy is an anatomically and technically feasible alternative to classical left posterolateral thoracotomy for bedside surgical PDA ligation.

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Ligation of patent ductus arteriosus in low birth weight premature infants: timing for intervention and effectiveness of bed-side surgery

Cited by 8 publications

References 11 publications

Bedside PDA ligation in premature infants less than 28 weeks and 1000 grams

Bedside PDA ligation in premature infants less than 28 weeks and 1000 grams

Ductal ligation timing and neonatal outcomes: a 12-year bicentric comparison

Bedside surgical ligation of the patent ductus arteriosus in very‐low‐birth‐weight premature infants: Limited upper ministernotomy as an alternative approach

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