Trends in patent ductus arteriosus ligation in neonates and changes in outcomes: A 10‐year multicenter experience

Abstract

Rationale The management of neonates with patent ductus arteriosus (PDA) has changed over time. Methods We conducted a single‐city, retrospective review of neonates who underwent PDA ligation over a 10‐year time period and compared infants from the first 5 years to the second 5 years to evaluate how clinical characteristics changed over this time. Results Infants from the second 5‐year epoch were older at time of ligation (38 vs. 30 days), had a higher ligation weight (1432 vs. 1121 g) and a lower incidence of postligation cardiac syndrome (1.9% vs. 11.5%). No differences in mortality, length of hospital‐stay or major morbidities were seen. Compared to neonates who underwent PDA ligation at ≤28 days of life, those with a ligation age >28 days had a higher ligation weight (1421 vs. 1039 g), a higher proportion of COX inhibitor use (92.5% vs. 83.8%), and a higher incidence of moderate‐severe bronchopulmonary dysplasia (BPD) (60.4% vs. 44.4%). Only 10.7% (25/233) patients were evaluated by laryngoscopy, in which the incidence of vocal cord paralysis (VCP) was 36.0%; 2 patients were clinically diagnosed with VCP for a total 4.7% incidence of VCP (11/233). Conclusions Over the 10 years examined, neonates underwent PDA ligation at an older age in the second 5‐year time period; this change was not associated with a change in the incidence of major morbidities. Ligation age >28 days was associated with an increase incidence of moderate‐severe BPD. The overall incidence of documented VCP post‐PDA ligation was relatively low but was seen in over 1/3 who were evaluated by laryngoscopy.

Effects of Milrinone on Neonates after Patent Ductus Arteriosus Ligation: A Retrospective Nationwide Database Study

“…Postligation cardiac syndrome (PLCS) is a phenomenon of hemodynamic instability that manifests as postoperative hypoxemia and hypotension and requires prolonged respiratory support [9]. PLCS occurs in 7.2-44% of patients who undergo PDA ligation [10][11][12][13][14] and can result in mortality, morbidities (such as BPD and NEC), and the need for home oxygen therapy [10,13,14]. Milrinone, a selective phosphodiesterase III inhibitor, is administered following PDA ligation for the prevention and treatment of PLCS [15][16][17][18].…”

Personalisierte Medizin beim medikamentösen Verschluss des persistierenden Ductus arteriosus - ein Vergleich zwischen konventioneller Ibuprofen-Therapie und einem patientenadaptierten/individualisierten Indometacin-Therapieschema

“…Unabhängig von der PDA-Ligatur berichteten Andropoulos und Greene (2017) über eine eingeschränkte neurokognitive Entwicklung nach Allgemeinnarkosen bei Kindern im Alter von unter drei Jahren. Als weitere Komplikation zeigte sich in einer Studie vonWang et al (2021) eine Stimmbandlähmung bei einem Drittel der durch Laryngoskopie untersuchten Patienten nach PDA-Ligatur. Dies zeigt, wie wichtig es ist, die Erfolgsrate der medikamentösen Therapie des PDA zu optimieren.…”