Ligation of a patent ductus arteriosus under fentanyl anesthesia improves protein metabolism in premature neonates

Abstract

Background/Purpose: Although surgical ligation effectively reverses the cardiopulmonary failure associated with patent ductus arteriosus (PDA), previous findings have suggested that such surgery itself elicits a catabolic response in premature neonates. Therefore, the authors sought to quantitatively assess whether PDA ligation under fentanyl anesthesia aggravated or improved the protein metabolism of premature neonates. Methods: Seven ventilated, premature neonates (birth weight 815 ± 69 g) underwent PDA ligation with standardized fentanyl anesthesia (15 μg/kg) on day-of-life 8.4 ± 1.2 and were studied immediately pre- and 16 to 24 hours postoperatively while receiving continuous total parenteral nutrition (TPN). Whole-body protein kinetics were calculated using intravenous 1-[13C]leucine, and skeletal muscle protein breakdown was measured from the urinary 3-methylhistidine to creatinine ratio (MH:Cr). Results: Whole-body protein breakdown (10.9 ± 1.2 v 8.9 ± 0.8 g/kg/d, P <.05), turnover (17.4 ± 1.2 v 15.4 ± 0.8 g/kg/d, P <.05), and MH:Cr (1.95 ± 0.20 v 1.71 ± 0.16 μmol:mg, P <.05) decreased significantly after operation. This resulted in a 60% improvement in protein balance (1.6 ± 0.8 v 2.6 ± 0.6 g/kg/d, P = 0.08) postoperatively. Conclusions: Because of decreased whole-body protein breakdown, whole-body protein turnover, skeletal muscle protein breakdown, and increased protein accrual, surgical PDA ligation under fentanyl anesthesia promptly improves the protein metabolism of premature neonates enduring the stress of a PDA. J Pediatr Surg 35:1277-1281. Copyright © 2000 by W.B. Saunders Company.