639 Morbidity Post Surgical Patent Ductus Arteriosus Ligation in Very Low Birth Weight Infants (VLBW)

Abstract

Background: PDA ligation in premature infants has low surgical morbidity but substantial late mortality and high incidence of morbidity in the survivors. Recently, PDA ligation has been associated with poorer neurosensory outcomes compared with medical treatment alone. In addition the systemic inflammatory response associated with surgery has been postulated to contribute to poor neurodevelopmental outcomes. Aim: To identify and evaluate the presence of morbidities following surgical ligation of PDA. Methods: Infants who had a surgical PDA ligation in Ireland over 6 years were included in this study if birth weight< 1500g or < 32 weeks gestation. Exclusions were made on the basis of concomitant severe congenital abnormalities. We included Vermont Oxford Network data outcomes from infants born in Dublin. Results: 132(35%) infants were included in the study having a mean gestational age of 26.5 (range: 23-32.2) weeks, birth weight 882 (range: 440-1470 g) and male infants numbered seventy (53%). Within the cohort, 77 infants were referred for surgical ligation from Dublin maternity hospitals and followup data was available for 73 infants: 15(20%) developed NEC with 7(9%) undergoing further surgery for NEC, 24% required laser for ROP, 69 had RDS, 8 had pneumothorax, GI Perforation was noted in 3 infants, and a bacterial pathogen was isolated in 10 infants. Baseline inflammatory indices were also significantly altered postoperatively with reduced Alb, Plts, monocytes and lymphocytes. Conclusion: Infants undergoing PDA ligation have an increased percentage of RDS, NEC, pneumothorax, and GI perforation, although ROP is lower than the Vermont Oxford Network data.