Efficiency and Safety of Patent Ductus Arteriosus Surgical Ligation in
Extremely Low Birth Weight Infants Without Chest Tube Placement
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Abstract
Patent ductus arteriosus (PDA) has been associated with increased
morbidity and mortality in preterm infants. Surgical ligation (SL) is
generally performed in symptomatic infants when medical management is
contraindicated or has failed. We retrospectively reviewed our
institution’s experience in surgical management of PDA for extremely low
birth weight (ELBW) infants without chest tube placement assessing its
efficiency and safety. We evaluated 17 consecutive ELBW infants
undergoing SL for symptomatic PDA (January 2012- January 2018) with
subsequent follow-up for 6 months postdischarge. Patients consisted of 9
(53%) females and 8 (47%) males. Mean gestational age (GA) at birthwas
27.9 +/- 2.1 weeks. Median values for surgical age (SA) from birth to
operation was 10 days (interquartile range [IQR]: 8-12); PDA diameter
3.4mm (IQR: 3.2- 3.5); surgical weight (SW) 750 g (IQR: 680-850); and
days of mechanical ventilation (DMV) as estimated by Kaplan-Meier curve
22 days (95% confidence interval: 14.2-29.8). We observed a
statistically significant negative association between DMV and GA at
birth (rho = - 0.587, p = 0.017), SA (rho = - 0.629, p = 0.009) and SW
(rho = - 0.737, p = 0.001). One patient experienced left laryngeal nerve
palsy confirmed by laryngoscopy. Otherwise, there were no adverse events
to include surgical-related mortality, recurrence of PDA, or need for
chest tube placement during follow-up. SL of PDA in ELBWinfants without
chest tube placement is both efficient and safe. Universal consensus
recommendations for the management of PDA in ELBW neonates are needed.
Further study is required regarding the use of the less invasive option
of percutaneous PDA closure in ELBW infants