Abstract
Introduction: There are still uncertainties about the timing and indication for surgical ligation of patent ductus arteriosus (PDA) in pre-term infants, where lower gestational age (GA) usually is predictive for surgical treatment.Objective: Our aim was to assess differences in clinical characteristics and outcomes between surgically treated and matched non-surgically treated PDA in extremely pre-term infants.Methods: All extremely pre-term infants born 2010–2016 with surgically treated PDA (Ligated group; n = 44) were compared to non-surgically treated infants (Control group; n = 44) matched for gestational age (+/−1 week) and time of birth (+/−1 month). Perinatal parameters, echocardiographic variables, details of pharmacological PDA treatment, morbidity, and mortality were assessed.Result: Mean GA and birthweight were similar between the Ligated group (24+5 ± 1+3 weeks and 668 ± 170 g) and the Control group (24+5 ± 1+3 weeks and 704 ± 166 g; p = 1.000 and p = 0.319, respectively). Infants in the Ligated group had larger ductal diameters prior to pharmacological treatment, and lack of diameter decrease and PDA closure after treatment (p = 0.022, p = 0.043 and 0.006, respectively). Transfusions, post-natal steroids and invasive respiratory support were more common in the Ligated group. Except for a higher incidence of severe bronchopulmonary dysplasia (BPD) in the Ligated group there were no other differences in outcomes or mortality between the groups.Conclusion: Early large ductal diameter and reduced responsiveness to pharmacological treatment predicted the need for future surgical ligation in this matched cohort study of extremely pre-term infants where the effect of GA and differences in treatment strategies were excluded. Besides an increased incidence of severe BPD in the Ligated group, no other differences in morbidity or mortality were detected.
Highlights
There are still uncertainties about the timing and indication for surgical ligation of patent ductus arteriosus (PDA) in pre-term infants, where lower gestational age (GA) usually is predictive for surgical treatment
Surgery was reserved for infants with persistent hemodynamically significant PDA where either contraindications for pharmacological treatment were present or for infants that did not respond to pharmacological treatment [4,5,6]
Continuous variables are presented as mean ± standard deviation or median and interquartile range (IQR), and categorical variables are presented as number and percent
Summary
There are still uncertainties about the timing and indication for surgical ligation of patent ductus arteriosus (PDA) in pre-term infants, where lower gestational age (GA) usually is predictive for surgical treatment. There are still uncertainties about the diagnostic criteria and treatment strategies for patent ductus arteriosus (PDA) in pre-term infants, and in extremely pre-term newborn infants [1, 2]. Before pharmacological treatment was available, early surgical ligation was performed to close PDA in pre-term infants [3]. As the initial reduction in morbidity after surgical closure did not translate into improved outcomes, pharmacological treatment with cyclooxygenase inhibitors or acetaminophen eventually became the first-hand choice for PDA treatment. Surgery was reserved for infants with persistent hemodynamically significant PDA where either contraindications for pharmacological treatment were present or for infants that did not respond to pharmacological treatment [4,5,6]. Arguments have been presented in favor of conservative management of PDA with neither pharmacological nor surgical treatment in pre-term infants [8,9,10]
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