P18 BPSU UK study of surgical closure of the patent ductus arteriosus – procedures and pathways

Abstract

IntroductionManagement of the patent ductus arteriosus (PDA) in premature babies includes none, conservative management with diuretics, medical treatment to close the PDA, or surgical closure. When and if to close the PDA is controversial. We chose to study the population who undergo surgical closure of a PDA as a representation of those for whom the PDA is clearly thought to require closure. We wished to describe this specific population. In this abstract we describe their pathways of care and procedures.MethodsData were collected using the British Paediatric Surveillance Unit (BPSU) methodology. Those undergoing surgical closure of a PDA between 1st September 2012 and 30th September 2013 were reported monthly to the BPSU by Consultant Neonatologists, Paediatricians, Cardiologists and Cardiothoracic Surgeons. Eligibility criteria were birth gestational age less than 37 weeks, closure prior to first discharge home and absence of other congenital cardiac disease. Questionnaires were then sent to reporting Consultants and the data from these collated and analysed. Missing data or discrepancies were clarified through email or telephone contact.ResultsOver 13 months, 531 notifications were received. 68 did not meet inclusion criteria. 58 were not returned. The response rate (excluding ineligible notifications) was 405/463(87%). After merging questionnaires related to the same patient and excluding incomplete questionnaires, 268 patients with the minimum complete data set remained. Data are presented for the data available which is not 268 for all points.Surgical closure of the PDA was performed in 14 centres. The number of ligations performed in these centres varied from 1 to 50 over the 13 month study period.Contact was made with 1, 2 or 3 cardiothoracic centres in 153, 25 and 3 cases respectively to arrange the ligation. 56 babies had their procedure in the same hospital. For the 199 who had to move hospital, the average distance was 28.4 miles. 105/157 procedures were performed as day cases. 11 out of 14 centres performed day cases with 6 performing over half as day cases. 7 cases were performed as catheter occlusions (20 missing data).ConclusionsThere is wide variation in the number of ligations performed by each centre. Of those reported many were performed as day cases. A small number are performed by catheter occlusion. Referral practice is non-uniform across the UK.