Surgical Ligation for Patent Ductus Arteriosus in Extremely Premature Infants: Strategy to Reduce their Risk of Neurodevelopmental Impairment

Abstract

Surgical ligation for patent ductus arteriosus (PDA) in extremely low birth weight infants (ELBWIs) has been shown a possible association with neurodevelopmental impairment (NDI) because of its invasiveness. However, we have undergone surgical ligation for ELBWIs immediately after cyclooxygenase inhibitor failed to close a hemodynamically significant PDA (hsPDA) to maintain proper systemic circulation. We aimed to determine the effect of surgical ligation for hsPDA on NDI in ELBWIs. In enrolled 71 ELBWIs, the clinical parameters, including the developmental quotient (DQ), were collected and compared among three groups that were divided by closure mode: spontaneous closure (n = 11), cyclooxygenase inhibitor therapy (n = 37) and surgical ligation (n = 23). No significant differences in DQ at the age of 36 months among the three groups were found: Median (interquartile range): 92.0 (31.0), 89.0 (22.0) and 92.0 (24.5), respectively. In a comparison between groups of DQ < 70 (n = 15) and DQ ≥ 70 (n = 56), a significant difference was found in the parameters related to prematurity (p < 0.05 for each): gestational age [23.9 (1.70) vs. 25.4 (2.50) weeks], birth weight [595 (183) vs. 714 (192) g], Apgar score < 5 (1 min) (67% vs. 36%), and laser photocoagulation for retinopathy of prematurity (73% vs. 43%), but there was no significant association with hsPDA. Therefore, we propose that surgical ligation for hsPDA in ELBWIs should be immediately carried out for preventing future neurodevelopmental deterioration if the cyclooxygenase inhibitor failed to close hsPDA.

Fibulin-1 Integrates Subendothelial Extracellular Matrices and Contributes to Anatomical Closure of the Ductus Arteriosus

“… 2 Patent DA (PDA) increases the mortality risk of premature infants. 3 , 4 Since the mid-1970s, COX inhibitors targeting smooth muscle cell (SMC) contraction represent the only pharmacological treatment for PDA, but >30% of these patients are still resistant to COX inhibitor therapy. 2 COX inhibitors have serious side effects on premature infants such as renal failure and neonatal necrotizing enterocolitis.…”

Results of the Patent Ductus Arteriosus Closure Using the Video-Assisted Thoracoscopic Surgery

“…Many studies have been conducted to examine the mortality rate of this method. For example, Satoko et al (2016) reported a mortality rate of 9.9% and neurological disorder prevalence of 21.1% in this method (5), which depicts a declining trend compared to the previous studies (13% and 44%, respectively) (6). In our study, the 30-day mortality rate of patients was zero, though investigation with a larger sample size is required to confirm the results.…”

Efficiency and Safety of Patent Ductus Arteriosus Surgical Ligation in Extremely Low Birth Weight Infants Without Chest Tube Placement

“…The authors suggested two possible explanations for these findings to include shorter time to exposure to both PDA duration and cumulative pharmacological side effects. In another study by Ito et al, 22 the authors suggested immediate SL of PDA in ELBW infants if medical treatment fails to minimize the duration of exposure to a hemodynamically significant PDA and to prevent future NDI. Vida et al 23 also reported the benefits of early PDA SL in premature infants <32 weeks of GA after two failed ibuprofen cycles (median age at PDA closure 8 days in early group vs. 14 days in late group; p < 0.0001), especially in reducing the risk of BPD and acute renal failure, highlighting that prolonging medical treatment to avoid SL can be associated with increased morbidity and hospital length of stay.…”