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SURGICAL PATENT DUCTUS ARTERIOSUS LIGATION IN VERY LOW BIRTH WEIGHT INFANTS: HOW SAFE IS IT?
  1. P J Shukla1,
  2. E J Molloy2,
  3. A El-Khuffash2,
  4. L Nolke3,
  5. K Walsh4
  1. 1University College Dublin, Dublin, Ireland
  2. 2Department of Neonatology, National Maternity Hospital, Dublin, Ireland
  3. 3Department of Pediatric Cardiothoracic Surgery, Our Lady’s Hospital for Sick Children, Dublin, Ireland
  4. 4Department of Pediatric Cardiology, Our Lady’s Hospital for Sick Children, Dublin, Ireland

Abstract

Introduction Patent ductus arteriosus (PDA) is a significant cause of morbidity and mortality in premature neonates, resulting in congestive heart failure, prolonged ventilator dependency and an increased incidence of chronic lung disease (CLD). PDA ligation in premature infants has been shown to have low surgical morbidity. However, there is substantial late mortality and high incidence of morbidity in the survivors, especially if ligation performed at >3 weeks of age. In addition, the systemic inflammatory response associated with surgery has been postulated to contribute to poor neurodevelopmental outcomes.

Methods Infants <1500 g who had a PDA ligation in Ireland were identified using HIPE data. Candidates were excluded for the presence of other congenital abnormalities.

Results 132 infants <1500 g had a PDA ligation in Ireland in a 6-year period. The median birth weight was 842.5 g and gestation 26.3 weeks. The day of diagnosis of PDA was 4 days and 33 were treated with ibuprofen and 60 with indomethacin. 11 hospitals referred infants for ligation during this period. There was no difference in time to ligation depending on referral from a rural or urban setting. There was no operative mortality or morbidity and infants were discharged postoperatively on day 1 (1–2). Age at PDA ligation was 23 days and 75 infants were >3 weeks old. Platelets, urea, creatinine and albumin were significantly altered postoperatively.

Conclusion Access to PDA ligation in Ireland has no geographical variation. No operative mortality was found. Prospective data collection is vital to assess long-term outcomes in preterm infants associated with PDA ligation.

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