Abstract
BackgroundThe aim of this study was to determine the feasibility and outcomes of early surgical ligation in preterm neonates with hemodynamically significant patent ductus arteriosus (HSPDA) and to investigate predictors for surgical treatment after unsuccessful medical management.MethodsMedical records from the neonatal intensive care unit of Hanyang University Seoul Hospital from January 2010 to December 2018 were retrospectively reviewed. 233 preterm neonates weighing less than 1500g with HSPDA were enrolled in our study. Of these preterm neonates, 134 underwent surgical ligation and were subdivided into the early ligation group (n = 49; within 10 days of age) and the late ligation group (n = 85; after 10 days of age).ResultsThe mean gestational age and birth weight were significantly lower in the patent ductus arteriosus (PDA) ligation group than in the Non-ligation group (p < 0.001). PDA ductal diameter > 2.0 mm (p < 0.001), low Apgar score at 5 min (p = 0.033), and chorioamnionitis (p = 0.037) were the predictors for receiving surgical treatment for PDA. Early ligation was significantly associated with a low incidence of culture-proven sepsis (p = 0.004), mechanical ventilator time > 4 weeks (p = 0.007), necrotizing enterocolitis stage (NEC) ≥ III (p = 0.022), and intraventricular hemorrhage (IVH) grade ≥ III (p = 0.035).ConclusionsEarly surgical ligation minimizes the adverse effects of HSPDA in predicted preterm neonates who subsequently require surgical treatment for PDA. This result suggests that in preterm neonates weighing less than 1500g with HSPDA that is unresponsive to medical treatment, delayed ductal closure should be avoided to reduce severe NEC, severe IVH, culture-proven sepsis, and facilitate earlier endotracheal extubation.
Highlights
The aim of this study was to determine the feasibility and outcomes of early surgical ligation in preterm neonates with hemodynamically significant patent ductus arteriosus (HSPDA) and to investigate predictors for surgical treatment after unsuccessful medical management
Hemodynamically significant patent ductus arteriosus (HSPDA) in preterm neonates has been proven to increase morbidities such as necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), heart failure and renal hypoperfusion [5,6,7,8], no randomized clinical trial has shown the benefit or efficacy of surgical ligation compared with no Patent ductus arteriosus (PDA) ligation in preterm neonates with HSPDA that is refractory to medical treatment [9]
Histologic chorioamnionitis was significantly higher in the PDA ligation group than in the Non-ligation group (p = 0.027), while pregnancy-induced hypertension (PIH) was significantly lower in the PDA ligation group than in the Non-ligation group (p = 0.031)
Summary
The aim of this study was to determine the feasibility and outcomes of early surgical ligation in preterm neonates with hemodynamically significant patent ductus arteriosus (HSPDA) and to investigate predictors for surgical treatment after unsuccessful medical management. Hemodynamically significant patent ductus arteriosus (HSPDA) in preterm neonates has been proven to increase morbidities such as necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), heart failure and renal hypoperfusion [5,6,7,8], no randomized clinical trial has shown the benefit or efficacy of surgical ligation compared with no PDA ligation in preterm neonates with HSPDA that is refractory to medical treatment [9]. The goal of this study was to analyze the feasibility of early surgical ligation (within 10 days of age) in preterm neonates with HSPDA and to investigate parameters that would be helpful for deciding on early surgery PDA surgical ligation after unsuccessful medical treatment is a definitive treatment, studies on the proper timing of surgery for HSPDA are few [4, 6], and the proper timing of surgical ligation remains controversial.
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