A Comparison of On-Site and Off-Site Patent Ductus Arteriosus Ligation in Premature Infants

Abstract

The data demonstrate that an experienced team can perform PDA ligation safely in NICUs of hospitals without on-site pediatric cardiac surgical capabilities in critically ill neonates without incurring the risks inherent in patient transport. Most importantly, patient care is continued by the neonatology team most familiar with the infant's medical and social history, and the patient's family is minimally inconvenienced.

Patent Ductus Arteriosus in Preterm Infants

“…34 The risk of this complication appears to decline substantially over the first 6 weeks after birth. 35 Long-term complications of surgical ligation include paresis of the left vocal cord 36,37 or diaphragm, 38 chylothorax, [38][39][40] and scoliosis, 41,42 and infants who undergo surgical ligation are more likely to develop BPD, [43][44][45] retinopathy of prematurity, 45 and neurodevelopmental impairment. 45,46 Treatment with cyclooxygenase inhibitors may lead to impaired renal function, 47 intestinal perforation, 48,49 and altered cerebrovascular regulation.…”

Cerebral blood volume changes during closure by surgery of patent ductus arteriosus

“…Surgical closure is the preferred treatment if pharmacotherapy fails to close the PDA. Performing surgery in the neonatal intensive care unit makes the procedure less harmful for unstable infants, but surgical closure of a PDA still carries the risk of acute haemodynamic changes and compromised cerebral perfusion in highly vulnerable preterm infants 4. Increased rates of neurosensory impairment in extremely low birth weight infants have been associated with surgical closure of a PDA 5.…”

Düşük doğum ağırlıklı erken doğmuş bebeklerde patent duktus arteriyozus ligasyonu: transport riski

“…When appropriate conditions can not be provided (for example, in NICUs which do not include a cardiovascular surgery unit), bed-side PDA closure is one of the surgical options for surgical treatment of PDA (7,8). Bed-side ligation was shown to decrease complications related to transport and ventilator (7,8).…”