Immediate and midterm adverse events after the surgical closure of the patent ductus arteriosus in preterm newborns

Abstract

Patent ductus arteriosus (PDA) in preterm newborns increases morbimortality. Nevertheless, PDA closure is controversial and could be risky. The aim of this study is to depict the adverse events (AE) related to PDA surgical closure, and their neurologic impact at 2 years old. In a retrospective monocentric study, all preterm newborns < 32 weeks of gestation and < 1.5 kg at birth who underwent PDA surgical closure from January 2010 to December 2019 were included. Global AE distinguished as surgical, hemodynamic (inotropic support for > 48 h, lactates increase or oliguria) and respiratory (High Frequency Oscillations ventilation > 24 h) were collected. Associated risk factors were searched. Impact of the AE on the neurologic development at 2 years was investigated. In all, 256 patients were included with mean gestational age of 25 weeks ± 1.41 and mean weight of 830.2 g ± 187.6. Global AE rate was 56.6% with 0% mortality. Eighty-six patients (33.5%) had a respiratory AE, 58 (22.6%) a hemodynamic AE and 53 (20.7%) a surgical AE, of which the most frequent was vocal cords paralysis (14.4%). There is no risk factor associated with surgical complications. Extended mechanical preoperative ventilation (> 11 days) was associated with more hemodynamic and respiratory AE ( P = 0.01, AUC = 0.61 and P = 0.03, AUC = 0.58 respectively). Low birth weight was associated with hemodynamic AE ( P = 0.003, AUC = 0.63, threshold < 690 g). The need of oxygen supplementation at the day of surgery was related to respiratory AE ( P < 0.0001, AUC = 0.68, threshold ≥ 28%). At 2 years old, language impairment was more frequent in case of occurrence of global AE ( P = 0.02) and more precisely, surgical complications ( P = 0.03) ( Fig. 1 ). PDA surgical closure is safe. Most of the AE are transient and more common in low birth weight or delayed closure in symptomatic patients. Long term complications such as language impairment was related to AE occurrence.