Bedside PDA ligation in premature infants less than 28weeks and 1000 grams.

Mustafa Kemal Avsar,Tolga Demir,Cem Celiksular,Cenap Zeybek

doi:10.1186/s13019-016-0539-3

Abstract

BackgroundPDA(Patent ductus arteriosus) is a common and clinically important condition which is presented with a number of hemodynamic and respiratory problems such as intraventricular hemorrhage, pulmonary hemorrhage and necrotizing enterocolitis due to increased pulmonary blood flow and stealing from systemic circulation. The incidence of PDA among the infants that were born before the 28th gestational week is as high as 70 %; and spontaneous closure rates in very-low-birth-weight premature neonates(VLBWPN) is around 34 %. The onset, duration, and repeat number of consecutive courses of the prostaglandin synthesis inhibitor medication for PDA closure are still issues of debate. Bed-side PDA closure is a safe surgical procedure in both mature and premature babies. Here we aim to retrospectively present our 26 cases which were less than 28 weeks and 1000 grams that underwent bed-side PDA ligation.MethodsThis retrospective study included 26 VLBWPN with PDA that underwent bed-side ligation between 2012 and 2015. Babies were born before the 28th gestational week (23–27 weeks) and less than 1000 grams (489–970 gr). Of the 26, 15 were female and 11 were male. Indomethacin was administered to all of the cases as the medical closing agent. The medication was stopped due to unwanted effects in 6 cases. All of the patients took medical treatment before surgery.ResultsNo surgical mortality occurred during our study. One case of pneumothorax was recorded as late surgical complication. Five of the 26 patients were lost, and the most common cause of mortality was sepsis (in 3 cases). The remaining 21 cases were discharged on days 86–238. The follow-up periods of the patients were 2 moths - 3 years. The most frequent problems encountered after discharge was chronic lung problems.ConclusionsBed side PDA ligation surgery in the ICU is a safe method for VLBWPN with clinically significant PDA.

Highlights

PDA(Patent ductus arteriosus) is a common and clinically important condition which is presented with a number of hemodynamic and respiratory problems such as intraventricular hemorrhage, pulmonary hemorrhage and necrotizing enterocolitis due to increased pulmonary blood flow and stealing from systemic circulation
Following a single course of indomethacin, PDA closure was evaluated by echocardiography
No patient was operated without prior medical treatment

Summary

Introduction

PDA(Patent ductus arteriosus) is a common and clinically important condition which is presented with a number of hemodynamic and respiratory problems such as intraventricular hemorrhage, pulmonary hemorrhage and necrotizing enterocolitis due to increased pulmonary blood flow and stealing from systemic circulation. The incidence of PDA among the infants that were born before the 28th gestational week is as high as 70 %; and spontaneous closure rates in very-low-birth-weight premature neonates(VLBWPN) is around 34 %. The important consequences of increased pulmonary blood-flow and stealing from systemic circulation due to left-to-right shunt in PDA include numerous hemodynamic and respiratory problems, such as intraventricular hemorrhage, pulmonary hemorrhage, pulmonary edema, necrotizing enterocolitis, retinopathy, decreased renal functions and chronic lung disease [1]. The incidence of PDA among premature babies less than 28 weeks and 1000 grams is as high as 70 %, and the rate of spontaneous closure in VLBWPN is about 34 %. Ko et al advocate that ligation should be the treatment of choice for symptomatic PDA because of the increased risks brought with

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