Patent Ductus Arteriosus Surgery Research Articles

Nasal High-Frequency Oscillatory Ventilation versus Nasal Intermittent Positive Pressure Ventilation In Pre-terms With Respiratory Distress Syndrome During Early Neonatal Period: A Randomized Controlled Trial

Objective: To determine the effectiveness of NHFOV versus NIPPV in reducing the need for invasive mechanical ventilation in preterm neonates with RDS (moderate-severe) during the first seven days of the life of neonate.
 Study Design: Randomized controlled study (ACTRN: 12622000291785).
 Place and Duration of Study: Neonatal Unit, PNS Shifa Hospital, Karachi Pakistan, from Jan to Aug 2021.
 Methodology: Forty-eight preterm neonates, with the gestational age of 27 weeks to 34 weeks with Respiratory distress Syndrome, were randomized to NHFOV Group (n=24) and NIPPV Group (n=24). The primary outcome was the need for invasive mechanical ventilation (IMV). The secondary outcomes were the duration of hospitalization, non-invasive respiratory support, mortality, abdominal distention, pneumothorax, need for surgery for patent ductus arteriosus, spontaneous intestinal perforation, and necrotizing enterocolitis, intraventricular haemorrhage≥ Grade-3, bronchopulmonary dysplasia, retinopathy of prematurity Stage-3.
 Results: There was no significant difference between NHFOV (64.7%) versus NIPPV (35.3%) groups in need of Invasive Mechanical Ventilation (p=0.13). Secondary outcomes were not significant between the two groups, air leak (p=0.31),necrotising enterocolitis (p=1.00), broncho-pulmonary dysplasia (p=0.31), retinopathy of prematurity (p=0.15).There was no intraventricular haemorrhage found between the two groups.
 Conclusion: Nasal high-frequency oscillatory ventilation was less statistically significant than NIPPV in reducing the need for invasive mechanical ventilation in the initial seven days of life in neonates with Respiratory distress syndrome.

Surgical ligation, not transcatheter closure, associated with a higher severity of bronchopulmonary dysplasia in extremely preterm infant intervened for patent ductus arteriosus.

Patent ductus arteriosus (PDA) is a common complication among premature infants, which may be responsible for prematurity-related complications such as bronchopulmonary dysplasia (BPD). It is unclear whether different interventional methods contribute to the severity of BPD, given the original National Institute of Child Health and Human Development (NICHD) 2001 definition. To date, surgical ligation and the transcatheter approach have been equally successful in premature infants with hemodynamically significant PDA after medical treatment failure. Immediate improvement in the respiratory condition has been reported after transcatheter closure. However, the short-term pulmonary outcome has not been clarified yet. This retrospective study investigated infants born with a body weight <1000 g and who underwent either surgical ligation or transcatheter closure of PDA in a single tertiary institution. The infants were divided into groups according to the type of procedure (surgical ligation or transcatheter occlusion). The primary outcome was the severity of BPD at discharge or at a postmenstrual age of 36 weeks. The outcome was analyzed with logistic regression. Forty-four patients met the inclusion criteria, of whom 14 underwent transcatheter occlusion and 30 underwent surgical ligation. The overall birth body weights and gestational age ranges were not different. The univariate model revealed an association between the procedure type and BPD severity. After adjusting for confounders, the multivariate model confirmed associations between BPD severity and procedure type and severe respiratory distress syndrome requiring surfactant. Compared with the transcatheter approach, surgery for PDA in extremely preterm infants is associated with severe BPD at discharge. Further large-scale studies are needed to determine the exact mechanism.

Management of patent ductus arteriosus in very preterm infants in England and Wales: a retrospective cohort study

ObjectiveTo describe the diagnosis and treatment of patent ductus arteriosus (PDA) in infants born at <32 weeks’ gestational age (GA) in England and Wales between 2010 and 2017.Study designRetrospective cohort...

Left Vocal Cord Paralysis, Lung Function and Exercise Capacity in Young Adults Born Extremely Preterm With a History of Neonatal Patent Ductus Arteriosus Surgery—A National Cohort Study

Background: Left vocal cord paralysis (LVCP) is a known complication of patent ductus arteriosus (PDA) surgery in extremely preterm (EP) born neonates; however, consequences of LVCP beyond the first year of life are insufficiently described. Both voice problems and breathing difficulties during physical activity could be expected with an impaired laryngeal inlet. More knowledge may improve the follow-up of EP-born subjects who underwent PDA surgery and prevent confusion between LVCP and other diagnoses.Objectives: Examine the prevalence of LVCP in a nationwide cohort of adults born EP with a history of PDA surgery, and compare symptoms, lung function, and exercise capacity between groups with and without LVCP, and vs. controls born EP and at term.Methods: Adults born EP (<28 weeks' gestation or birth weight <1,000 g) in Norway during 1999–2000 who underwent neonatal PDA surgery and controls born EP and at term were invited to complete questionnaires mapping voice-and respiratory symptoms, and to perform spirometry and maximal treadmill exercise testing. In the PDA-surgery group, exercise tests were performed with a laryngoscope positioned to evaluate laryngeal function.Results: Thirty out of 48 (63%) eligible PDA-surgery subjects were examined at mean (standard deviation) age 19.4 (0.8) years, sixteen (53%) had LVCP. LVCP was associated with self-reported voice symptoms and laryngeal obstruction during exercise, not with lung function or peak oxygen consumption (VO2peak). In the PDA-surgery group, forced expiratory volume in 1 second z-score (z-FEV1) was reduced compared to EP-born controls (n = 30) and term-born controls (n = 36); mean (95% confidence interval) z-FEV1 was −1.8 (−2.3, −1.2), −0.7 (−1.1, −0.3) and −0.3 (−0.5, −0.0), respectively. For VO2peak, corresponding figures were 37.5 (34.9, 40.2), 38.1 (35.1, 41.1), and 43.6 (41.0, 46.5) ml/kg/min, respectively.Conclusions: LVCP was common in EP-born young adults who had undergone neonatal PDA surgery. Within the PDA-surgery group, LVCP was associated with self-reported voice symptoms and laryngeal obstruction during exercise, however we did not find an association with lung function or exercise capacity. Overall, the PDA-surgery group had reduced lung function compared to EP-born and term-born controls, whereas exercise capacity was similarly reduced for both the PDA-surgery and EP-born control groups when compared to term-born controls.

Evaluation of postoperative complications for patent ductus arteriosus in extremely-low-birthweight infants.

Patent ductus arteriosus (PDA), which disrupts the hemodynamics early after birth, causes intraventricular hemorrhage and neonatal necrotizing. Unlike medical treatment for hemodynamically significant PDA, there are institutional disparities in the criteria for surgical treatment METHODS: We aimed to clarify the postoperative indications of surgery for hemodynamically significant PDA and the postoperative complications associated with surgery. Thirty-six extremely-low-birthweight infants (median gestational age 25.2 weeks, median birthweight 699 g) required video-assisted thoracoscopic surgery for PDA (VATS-PDA). The treatment indication of VATS-PDA was resistance to medical treatment in 17 cases, relapsed PDA in 15 cases, and no additional administration of indomethacin because of severe side effects in four cases. Complications with VATS-PDA occurred in eight of 36 cases. There were three cases of pneumothorax, two of thoracotomy transition, two of pulmonary hemorrhage, and four of post-ligation cardiac syndrome (PLCS). VATS-PDA-related death occurred in two cases due to PLCS. The frequency of four or more administrations of indomethacin, with or without postoperative complications, was 88% vs. 39%, respectively (P = 0.04). All postoperative deaths were caused by PLCS, which had the highest risk of poor prognosis. VATS-PDA should be considered for unclosed PDA after one course of indomethacin administration.

Hospital Outcomes of Surgical Closure of Patent Ductus Arteriosus: 19 Years Experience at Shahid Gangalal National Heart Center

Background Ductus arteriosus is a vascular structure which connects the roof of main pulmonary artery near the origin of the left branch pulmonary artery to the proximal descending aorta. Patent ductus arteriosus (PDA) closure is indicated for any patient who is symptomatic from left to right shunting.&#x0D; Objective To investigate the hospital outcomes of surgical closure of patent ductus arteriosus over last 19 years starting from the very first case of our center.&#x0D; Method This is a retrospective analysis of all patent ductus arteriosus treated surgically from August 2001 to July 2019. Patients who underwent isolated surgical closure of patent ductus arteriosus were included. Data have been presented in three different eras (Era 1: 2001-2007, Era 2: 2008-2013, and Era 3: 2014-2019) to see the trend of evolution of this surgery.&#x0D; Result A total of 901 patients aged 8.67±8.76 years under went patent ductus arteriosus surgical closure over last 19 years. Patients in the initial era 2001-2007 were significantly older compared with other 2 eras (p=0.000). Males accounted for 35.5% of all cases. Twenty percent had severe pulmonary artery hypertension. Duration of mechanical ventilation was 3.57±9.64 hours with ICU stay of 1.55±1.53 days, and hospital stay of 3.9±2.3 days. Overall in hospital mortality was 0.8%; for isolated patent ductus arteriosus diagnosis, mortality was 0.2%. Chylothorax was noted in 0.4%.&#x0D; Conclusion This is the first report to analyze surgical outcomes of patent ductus arteriosus ligation in our center. We have discussed the evolution of patent ductus arteriosus surgery in our center, and have shown favorable outcomes in terms of morbidity and mortality.

Initial Experience With Patent Ductus Arteriosus Ligation in Pre-term Infants With Bidirectional Shunt Pattern.

Background: Patent ductus arteriosus (PDA) with a bidirectional shunt reflects critical clinical conditions. The operability of PDA with a bidirectional shunt in pre-term infants is still not clearly clarified. This study aimed to investigate the feasibility and the outcomes of PDA ligation in pre-term infants with a bidirectional shunt PDA.Methods: All pre-term infants receiving PDA ligation between 2013 and 2019 were enrolled in this prospective study. Patients were allocated into two groups based on the shunting direction of PDA, which were the left-to-right group (group A) and the bidirectional group (group B). Clinical characteristics and pre-op comorbidities were analyzed. Intraoperative complications, post-op neurological sequelae, necrotizing enterocolitis, survival, and mortality were compared between these two groups.Results: Thirty-seven pre-term infants were enrolled (18 in group A, 19 in group B). The mean post-menstrual age at PDA surgery was 32.0 ± 1.3 and 32.8 ± 1.5 weeks, respectively. Before surgery, 44.4 and 89.5% (group A vs. B) of the patients were using invasive mechanical ventilator (p < 0.01). The requirement of high-frequency oscillatory ventilatory support was significantly higher in group B. PDA rupture-related bleeding during exposing PDA or ligating PDA occurred in four infants, and all were all in group B, including one with delayed hemothorax. Early surgical mortality within 30 days of surgery was higher in group B (0 vs. 21.1%, p < 0.05), but only one death could be attributed to the surgery, which was caused by a pain-induced pulmonary hypertension crisis. The 5-year survival was 100% in group A, and 73.7% in group B (p < 0.05).Conclusion: We did not recommend routine PDA ligation in pre-term infants with a bidirectional shunt. However, a bidirectional shunt should not be an absolute contraindication if they fulfill indications of PDA closure. Unexpected intraoperative PDA rupture and delayed hemothorax in a bidirectional shunt PDA should be carefully monitored. Aggressive post-op pain control is also warranted to avoid pulmonary hypertension crisis. The post-op early mortality rate was higher in the bidirectional group, which could be inherent to their poor pre-operative lung condition. Only one death was directly related to the surgery.

Perioperative nutrition in extremely preterm infants undergoing surgery for patent ductus arteriosus

Summary Background and aims Patent ductus arteriosus is a common neonatal morbidity affecting more than half of infants born extremely preterm. Suboptimal nutrition in extremely preterm infants in general has been demonstrated in recent studies. The aim of this study was to describe perioperative nutritional practices in Swedish neonatal intensive care units caring for extremely preterm infants undergoing surgery for patent ductus arteriosus. Methods Daily enteral and parenteral nutritional intakes during the perioperative week starting three days prior and ending three days after surgery were retrospectively evaluated in five University hospitals caring for infants born Results In total, 132 infants and data from 912 perioperative days were included. Mean daily energy intakes during the perioperative week (range 78–105 kcal/kg/day) varied significantly between hospitals, with the lowest intakes on the day of surgery (range 54–87 kcal/kg/day). Mean daily protein intakes during the perioperative week did not vary (range 2.3–2.6 g/kg/day) but did differ on the day of surgery (range 1.5–2.4 g/kg/day). Median parenteral (range 33–99 mL/kg/day) and enteral (range 34–123 mL/kg/day) fluid intakes during the perioperative week, as well as median parenteral contents of energy and protein, varied significantly between hospitals. Conclusions Current recommended nutritional goals for extremely preterm infants were not met in the studied neonatal intensive care units. Suboptimal nutrition may have implications for short and long-term outcomes. Improved adherence to nutritional guidelines is warranted for these patients.

The type and timing of patent ductus arteriosus treatment was associated with neurodevelopment when extremely preterm infants reached 6.5years.

This study investigated patent ductus arteriosus (PDA) treatment and neurodevelopmental outcomes when extremely preterm born children reached 6.5years. Our cohort was 435 children with neonatal PDA treatment data and neurodevelopmental follow-up data, born in 2004-2007, who participated in the Extremely Preterm Infants in Sweden Study. Pharmacological or surgical PDA treatment and the age at PDA treatment, were investigated in relation to the risks of moderate to severe neurodevelopmental impairment (NDI) and full-scale intelligence quotient (FSIQ) at 6.5years. The children who received PDA drug treatment, including those who also had surgery, had the same risk of moderate to severe NDI or lower FSIQ as untreated children. However, children who had primary PDA surgery faced increased risks of NDI, with an adjusted incidence rate ratio of 1.62 (95% confidence interval [CI] 1.28-2.06) and a lower adjusted mean difference FSIQ of -7.1 (95% CI -11 to -3.2). Surgery at less than 10days of life was associated with a significantly increased risk of moderate to severe NDI and lower FSIQ than surgery after 20days. Drug treatment followed by deferred surgery appeared to be a safer option for extremely preterm infants severely affected by PDA.

Swallow Safety is Determined by Bolus Volume During Infant Feeding in an Animal Model.

Feeding difficulties are especially prevalent in preterm infants, although the mechanisms driving these difficulties are poorly understood due to a lack of data on healthy infants. One potential mechanism of dysphagia in adults is correlated with bolus volume. Yet, whether and how bolus volume impacts swallow safety in infant feeding is unknown. A further complication for safe infant swallowing is recurrent laryngeal nerve (RLN) injury due to patent ductus arteriosus surgery, which exacerbates the issues that preterm infants face and can increase the risk of dysphagia. Here, we used a validated animal model feeding freely to test the effect of preterm birth, postnatal maturation and RLN lesion and their interactions on swallow safety. We also tested whether bolus size differed with lesion or birth status, and the relationship between bolus size and swallow safety. We found very little effect of lesion on swallow safety, and preterm infants did not experience more penetration or aspiration than term infants. However, term infants swallowed larger boluses than preterm infants, even after correcting for body size. Bolus size was the primary predictor of penetration or aspiration, with larger boluses being more likely to result in greater degrees of dysphagia irrespective of age or lesion status. These results highlight that penetration and aspiration are likely normal occurrences in infant feeding. Further, when comorbidities, such as RLN lesion or preterm birth are present, limiting bolus size may be an effective means to reduce incidences of penetration and aspiration.

Voice and Exercise Related Respiratory Symptoms in Extremely Preterm Born Children After Neonatal Patent Ductus Arteriosus

Objective: To investigate voice characteristics and exercise related respiratory symptoms in extremely preterm born 11-year-old children, focusing particularly on associations with management of a patent ductus arteriosus (PDA).Study design: Prospective follow-up of all children born in Norway during 1999–2000 at gestational age <28 weeks or with birthweight <1,000 g. Neonatal data were obtained prospectively on custom-made registration forms completed by neonatologists. Voice characteristics and exercise related respiratory symptoms were obtained at 11 years by parental questionnaires.Result: Questionnaires were returned for 228/372 (61%) eligible children, of whom 137 had no history of PDA. PDA had been noted in 91 participants, of whom 36 had been treated conservatively, 21 with indomethacin, and 34 with surgery. Compared to the children treated with indomethacin or conservatively, the odds ratio (95% confidence interval) for the surgically treated children were 3.4 (1.3; 9.2) for having breathing problems during exercise, 16.9 (2.0; 143.0) for having a hoarse voice, 4.7 (1.3; 16.7) for a voice that breaks when shouting, 4.6 (1.1; 19.1) for a voice that disturbs singing, and 3.7 (1.1; 12.3) for problems shouting or speaking loudly. The significance of surgery per se was uncertain since the duration of mechanical ventilation was associated with the same outcomes.Conclusion: Extremely preterm born children with a neonatal history of PDA surgery had more problems with voice and breathing during exercise in mid-childhood than those whose PDA had been handled otherwise. The study underlines the causal heterogeneity of exercise related respiratory symptoms in preterm born children.

Distinct severity of phenotype in Hajdu-Cheney syndrome: a case report and literature review

BackgroundHajdu-Cheney syndrome (HCS) is a rare inherited skeletal disorder caused by pathogenic mutations in exon 34 of NOTCH2. Its highly variable phenotypes make early diagnosis challenging. In this paper, we report a case of early-onset HCS with severe phenotypic manifestations but delayed diagnosis.Case presentationThe patient was born to non-consanguineous, healthy parents of Chinese origin. She presented facial anomalies, micrognathia and skull malformations at birth, and was found hearing impairment, congenital heart disease and developmental delay during her first year of life. Her first visit to our center was at 1 year of age due to cardiovascular repair surgery for patent ductus arteriosus (PDA) and ventricular septal defect (VSD). Skull X-ray showed wormian bones. She returned at 7 years old after she developed progressive skeletal anomalies with fractures. She presented with multiple wormian bones, acro-osteolysis, severe osteoporosis, bowed fibulae and a renal cyst. Positive genetic test of a de novo heterozygous frameshift mutation in exon 34 of NOTCH2 (c.6426dupT) supported the clinical diagnosis of HCS.ConclusionThis is the second reported HCS case caused by the mutation c.6426dupT in NOTCH2, but presenting much earlier and severer clinical expression. Physicians should be aware of variable phenotypes so that early diagnosis and management may be achieved.

Optimal timing of video-assisted thoracoscopic surgery for patent ductus arteriosus in preterm infants born at≤28weeks of gestation.

Video-assisted thoracoscopic surgery for patent ductus arteriosus (VATS-PDA) is an alternative surgical procedure to open chest surgery, even in premature infants. This study investigated whether the timing of VATS-PDA has a prognostic impact in premature infants whose operative indication was determined according to the symptomatic PDA and the ineffectiveness of or contraindication to indomethacine therapy. We studied 49 infants born at or before 28weeks of gestation who were admitted to the neonatal intensive care unit between January 2004 and June 2016, and who underwent VATS-PDA. The patients were divided into two groups according to median age at the time of surgery (early group, 24 infants who underwent surgery at≤24days of life; late group, 25 infants who underwent surgery at≥25days of life). No significant differences were found in bodyweight at 30days of age and 40weeks of corrected gestational age between the groups. The timing of surgery did not affect the operative procedure or postoperative complications. In addition, no differences were observed between the early and late groups in terms of complications associated with prematurity, including intraventricular hemorrhage, incidence and severity of bronchopulmonary dysplasia, and necrotizing enteropathy. Video-assisted thoracoscopic surgery for patent ductus arteriosus can be safely performed in premature infants without a preferential timing for the intervention, suggesting that this procedure allows for an elective basis approach after heart failure management with conservative and/or drug therapy in premature infants with PDA.

Patent Ductus Arteriosus and the Effects of Its Late Closure in Preterm Infants with Severe Bronchopulmonary Dysplasia

Background: The natural history and optimal management of a patent ductus arteriosus (PDA) among infants with established severe bronchopulmonary dysplasia (sBPD) remains uncertain. Objectives: To describe the characteristics of PDA present at ≥36 weeks’ postmenstrual age (PMA) and the effects of late surgical PDA closure in a referral cohort of very preterm infants with sBPD. Study Design: This retrospective cohort study was performed in a tertiary neonatal intensive care unit. Study infants were born at <32 weeks’ gestation between 2010 and 2016, diagnosed with sBPD, and had an echocardiographic PDA at ≥36 weeks’ PMA. We reviewed echocardiograms performed closest to 3 time points (≥36 weeks’ PMA, hospital discharge, and 1 year of age) and assessed clinical outcomes among infants with versus without late PDA treatment. Results: Among 329 infants with sBPD, 59 had a PDA at ≥36 weeks’ PMA. Most PDAs were small (n = 33) and shunted left to right (n = 53). The PDA closed spontaneously prior to discharge in 5 of 21 infants who did not undergo surgical closure and decreased in size in 3. The PDA spontaneously closed by 1 year of age in 6 out of 12 infants with an open duct at discharge. PDA surgery (n = 23) at ≥36 weeks’ PMA was not associated with increased risk for the composite outcome of tracheostomy, systemic vasodilator at discharge, or death after adjusting for potential confounders (OR 3.2, 95% CI 0.81–13.0). Conclusions: The majority of conservatively treated late PDAs closed spontaneously or decreased in size.PDA surgery was not associated with severe adverse clinical outcomes.

Management of Congenital Heart Disease: State of the Art; Part I-ACYANOTIC Heart Defects.

Since the description of surgery for patent ductus arteriosus in late 1930s, an innumerable number of advances have taken place in the management of congenital heart defects (CHDs). In this review the current status of treatment of seven of the most common acyanotic CHDs was reviewed. The discussion included indications for, and timing of, intervention and methods of intervention. The indications are, by and large, determined by the severity of the lesion. Pressure gradients in obstructive lesions and the magnitude of the shunt in left-to-right shunt lesions are used to assess the severity of the lesion. The timing of intervention is different for each lesion and largely dependent upon when the criteria for indications for intervention were met. Appropriate medical management is necessary in most patients. Trans-catheter methods are preferable in some defects while surgery is a better option in some other defects. The currently available medical, trans-catheter, and surgical methods to treat acyanotic CHD are feasible, safe, and effective.

Birth weight, Apgar scores and gentamicin were associated with acute kidney injuries in VLBW neonates requiring treatment for patent ductus arteriosus.

We assessed the risk factors for transient acute kidney injury in very low birth weight (VLBW) infants treated for patent ductus arteriosus (PDA) using the serum creatinine-based criteria in Kidney Disease: Improving Global Outcomes. This retrospective study of infants requiring ibuprofen and, or, surgery for haemodynamic relevant PDAs was performed at the University Children's Hospital of Saarland, Homburg, Germany, from January 2009 to December 2015. We studied 422 infants with a mean birth weight of 1059 ± 308.2 g. Acute kidney injuries developed in 150/295 infants (50.9%) with spontaneous PDA closure, in 46/82 (56.1%) who received intravenous ibuprofen treatment, in 18/24 (75.0%) who had surgery and in 15/21 infants (71.4%) who received both medical and surgical treatment. Acute kidney injuries were associated with birth weight and gestational age, Apgar scores at 10 minutes, the PDA size corrected for birth weight, a PDA with three affected circulatory territories, PDA surgery and gentamicin. Multiple logistic regression analysis showed particular associations between acute kidney injury and birth weight (p = 0.001), the 10-minute Apgar score (p = 0.02) and gentamicin (p = 0.043). Birth weight, the 10-minute Apgar score and gentamicin were particularly associated with acute kidney injuries in our cohort.

Patent ductus arteriosus closure and somatic regional oxyhemoglobin saturation

The authors report a case of a 14-day-old infant patient with patent ductus arteriosus (PDA) with pulmonary hypertension. Accidental clipping of the left pulmonary artery (LPA) during intended PDA closure was revealed, and subsequent urgent PDA closure and releasing a clip of the LPA were conducted. During surgeries we measured somatic regional oxyhemoglobin saturation (rSO2) values and change in those might be a key for early diagnosis of accidental clipping of the LPA. These findings suggest that we should understand the risk of accidental closure of the LPA during PDA surgery and somatic rSO2 values will provide information for early diagnosis of critical complication.

Congenital rubella syndrome

This is a report of a very rare case of congenital rubella syndrome with congenital sensorineural hearing loss, rubella retinopathy, and congenital heart disease with patent ductus arteriosus. After the introduction of the rubella vaccine in 1969, the number of babies born with congenital rubella is much less and rare. Not all the babies born with congenital rubella have the classical triad. Hence, our patient who has all the features of the classical triad is an extremely rare one. The baby underwent surgery for patent ductus arteriosus and cochlear implant procedure for sensorineural hearing loss. She is now under follow-up with us for pigmentary retinopathy.

Infections following surgical patent ductus arteriosus ligation in very-low-birthweight neonates

Very-low-birthweight (VLBW) neonates (<1500g) comprise approximately 1% of liveborn infants in Poland. Patent ductus arteriosus (PDA) is a common complication of prematurity. This study aimed to determine how many VLBW neonates treated in the participating units needed surgical correction of PDA, and to evaluate the incidence of various types of postoperative infections and their microbiology. Observational study in five neonatology departments by the Polish Neonatology Surveillance Network, involving 2039 VLBW newborns of whom 103 (5.1%) required surgical PDA ligation. Continuous infection surveillance was conducted between 2009 and 2013; infections were defined based on Gastmeier's criteria. PDA surgery was required significantly more frequently in infants from multiple pregnancies, and where labour was complicated by amnionitis. Surgical PDA correction was performed, on average, at 19 days of life. The incidence of infection was 48.5% (N=50), and the most common infections were bloodstream infection (26.2%) and pneumonia (22.3%). A correlation was observed between the day on which the procedure was performed and the time of infection: the earlier the neonate underwent PDA surgery, the earlier the infection manifested (P=0.032). A high CRIB score and chorioamnionitis contributed significantly to the presence of infection. The later the PDA surgery was performed, the later the infection occurred. The incidence of infection after correction of PDA among VLBW neonates was comparable with the incidence of infection among all hospitalized VLBW neonates.

Efficacy of pharmacologic closure of patent ductus arteriosus in small-for-gestational-age extremely preterm infants

BackgroundOptimal management of the patent ductus arteriosus (PDA) in preterm infants remains controversial. Therefore, studies identifying infants who are most likely to benefit from PDA treatment are needed. AimWe sought to examine if significant intrauterine growth restriction, defined by birth weight z-score, reduces the efficacy of PDA closure with indomethacin or ibuprofen and thereby increases the need for surgical closure of PDA after pharmacologic treatment. Study design, subjects, and outcome measuresWe studied infants 23–28weeks' gestation born 2006–2013 at NICHD Neonatal Research Network centers. We examined the responses to PDA treatment with indomethacin and/or ibuprofen and whether the PDA was subsequently closed surgically. Logistic regression generated adjusted odds ratios (ORs) for the associations between the z-score groups (<−2, −2 to −0.5, and >−0.5) and PDA surgery following pharmacologic treatment. Results5606 infants were diagnosed with PDA; 3587 (64.0%) received indomethacin or ibuprofen or both, and 909 (25.3%) underwent PDA surgery. Mothers of infants with PDA non-closure were less likely to have hypertension (19% vs. 28%). Infants with non-closure were more likely to be female (53% vs. 49%), have lower gestational age and birth weight and to develop sepsis (42% vs. 31%). Compared to infants with z-score>−0.5, PDA surgery was increased among infants with z-score −2 to −0.5 (OR=1.23; 95% CI 1.02–1.47) but not among infants with z-score<−2. ConclusionInfants with birth weight z-score −2 to −0.5 are more likely than normally grown infants to require PDA surgery following pharmacologic treatment.