Anesthetic management of catheter‐based patent ductus arteriosus closure in neonates weighing <3 kg: A Retrospective Observational Study

Abstract

Background:The patent ductus arteriosus is a cardiac lesion commonly found in premature neonates. Though surgical closure via thoracotomy is the most definitive treatment option, it is associated with significant morbidity. New catheter-based closure options offer a potentially safer alternative treatment, even in premature neonates. However, no literature reports the anesthetic techniques, challenges, and risks associated with this procedure in this population. Aim: This study documents the anesthetic challenges and potential complications associated with the management of catheter-based closure of the ductus arteriosus in neonates under 3 kg. Methods: This single-center, retrospective study examined patients who underwent catheter-based ductus arteriosus closure between August 2015 and February 2019. A clinical protocol for anesthetic management of these patients was utilized throughout the study period. Clinical outcomes considered were new hemodynamic instability or vasoactive medication requirements, hypothermia, prolonged intubation (>3 days postoperatively), postprocedure acute kidney injury, perioperative red blood cell transfusion, and accidental extubation. Results: Seventy-six neonates underwent 78 procedures. No patient developed perioperative hemodynamic instability, vasoactive medication requirements, or acute kidney injury. Four patients (5%) required red blood cell transfusion, two (3%) became hypothermic, and one (1%) was accidentally extubated. Closure was achieved in 73 patients (96%) on the first attempt. However, 17 patients (40%) required prolonged periods of mechanical ventilation following the procedure. Conclusion: Despite multiple clinical and logistical challenges, anesthetic risk associated with catheter-based PDA closure in small neonates can be effectively managed through standardized and multidisciplinary care.

Trend and Outcomes for Surgical Versus Transcatheter Patent Ductus Arteriosus Closure in Neonates and Infants at US Children’s Hospitals

“… 11 In a cohort of neonates weighing <3 kg, Hubbard et al found that 40% of patients intubated for the purpose of the procedure required ongoing mechanical ventilation after TC. 33 We demonstrated a lower rate of mechanical ventilation among patients undergoing TC overall (19.3%).…”

Risk factors and outcomes of intraoperative hypothermia in neonatal and infant patients undergoing general anesthesia and surgery

“…Preterm infants and neonates should be transported in a warmed incubator, and if possible it should be considered to perform surgery in the NICU for high-risk patients ( 20 ). The interruption of prewarming also can result in hypothermia ( 39 ), and with an adequate prewarming protocol, hypothermia incidence can be reduced to 20% ( 10 ), even in preterm infants ( 40 ). Our study also showed that prewarming before induction of anesthesia could protect both infants and neonates suffering from intraoperative hypothermia, indicating that the prewarming management strategy should be implemented during the whole course of anesthesia and surgery or even during postsurgery recovery.…”

Interventions to prevent hypothermia in extremely preterm low-weight infants undergoing cardiac catheterisation

“…A recent retrospective observational study by Hubbard et al 6 on anaesthetic management of catheter-based PDA closure in neonates weighing <3 kg indicates that the prevalence of postoperative hypothermia is 3%. Similar approaches to thermal care were used in our study, such as transportation in prewarmed transport incubators, limiting cold exposure by placement of intravenous catheter and endotracheal tube in the NICU, forced air warming device, as well as increasing ambient air temperature.…”