Abstract
BackgroundAlthough patent ductus arteriosus (PDA) ligations in the Neonatal Intensive Care Unit (NICU) have been an accepted practice, many are still performed in the Operating Room (OR). Whether avoiding transport leads to improved perioperative outcomes is unclear. Here we aimed to determine whether PDA ligations in the NICU corresponded to higher risk of surgical site infection or mortality and if transport was associated with worsened perioperative outcomes.MethodsWe performed a retrospective cohort study of NICU patients, ≤37 weeks post-menstrual age, undergoing surgical PDA ligation in the NICU or OR. We excluded any infants undergoing device PDA closure. We measured the incidence of perioperative hypothermia, cardiac arrest, decreases in SpO2, hemodynamic instability and postoperative surgical site infection, sepsis and mortality.ResultsData was collected on 189 infants (100 OR, 89 NICU). After controlling for number of preoperative comorbidities, weight at time of procedure, procedure location and hospital in the mixed-effect model, no significant difference in mortality or sepsis was found (odds ratio 0.31, 95%CI 0.07, 1.30; p = 0.107, and odds ratio 0.40; 95%CI 0.14, 1.09; p = 0.072, respectively). There was an increased incidence of hemodynamic instability on transport postoperatively in the OR group (12.4% vs 2%, odds ratio 6.93; 95% CI 1.48, 35.52; p = 0.014).ConclusionPDA ligations in the NICU were not associated with higher incidences of surgical site infection or mortality. There was an increased incidence of hemodynamic instability in the OR group on transport back to the NICU. Larger multicenter studies following long-term outcomes are needed to evaluate the safety of performing all PDA ligations in the NICU.KeywordsPatent ductus arteriosus, Newborn infant, Neonatal intensive care unit, Surgical wound infection, Postoperative period, Hemodynamics
Highlights
The transport of extremely premature neonates from the Neonatal Intensive Care Unit (NICU) to the operating room (OR) is not without significant risk
The NICU cohort had a statistically significant lower birthweight, weight at time of procedure, gestational age, and post-menstrual age at time of procedure, compared to the OR cohort. The proportion of those who were small for gestational age versus appropriate for gestational age at time of birth were similar between the OR (17 and 76%, respectively) and NICU groups (13 and 84%, respectively)
Using a modified inotrope score to account for differences in type of inotrope and dosage [18], we found that the log of the mean inotrope score for the NICU group was higher than in the OR group, and that this was statistically significant (p = 0.011)
Summary
The transport of extremely premature neonates from the Neonatal Intensive Care Unit (NICU) to the operating room (OR) is not without significant risk These risks include inadequate monitoring, tracheal extubation, hypo/ hyperventilation, loss of vascular access, discontinuation of life-sustaining infusions, acute hemodynamic deterioration and hypothermia. Premature neonates who had patent ductus arteriosus (PDA) ligation [2,3,4,5] and other bedside surgical procedures [1, 6,7,8,9,10,11,12] performed in the NICU have not been shown to have an increased incidence of surgical site infections far. Patent ductus arteriosus (PDA) ligations in the Neonatal Intensive Care Unit (NICU) have been an accepted practice, many are still performed in the Operating Room (OR). We aimed to determine whether PDA ligations in the NICU corresponded to higher risk of surgical site infection or mortality and if transport was associated with worsened perioperative outcomes
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