241 Patent Ductus Arteriosus – Is Surgical Ligation Necessary? The Western Australian Experience

Abstract

Patent ductus arteriosus (PDA) with a significant left-right shunt is associated with chronic lung disease (CLD), intraventricular haemorrhage (IVH) and necrotising enterocolitis (NEC). Surgical ligation is reserved for PDA refractory to medical treatment, however there is no clear evidence that this improves outcome. WCHS is the only tertiary perinatal/paediatric centre in Western Australia. Geographical isolation from the nearest cardiac surgical centre (3,500kms) has meant that ductal ligation has not been an option until recently. A retrospective data analysis was undertaken to test the hypothesis that outcomes of infants with persistent PDA were no worse than that of those with a closed duct. Patients and Methods: Infants born 1.4 or a ductal diameter of > 1.5 mm with a left-to-right shunt. Continuous data is summarised as median (IQR) and analysed with Mann-Whitney and Kruskal-Wallis tests. Duration of ventilation, oxygen and hospital stay were estimated using Kaplan-meier probability estimates and analysed using Cox proportional hazards regression model Results Total 284 infants <28 weeks gestation were included and 32 excluded. Twenty-four (10%) infants died at median (IQR) 15.5 (9–35) days. Relative to Group 1, the infants in Group 3 were at increased risk of death (adjusted OR = 4.01 (95% CI 1.12–14.51) p= 0.033). Deaths: Group1= 6/154; Group2= 7/65; Group3: deaths= 11/33. There was no significant difference between groups in the incidence of CLD, CLD or death, NEC, IVH, duration of oxygen or hospital stay but duration of ventilation tended to be longer in Group 3 (adjusted HR 0.66 (95% CI 0.41–1.06) p=0.082.