Respiratory Trajectory after Invasive Interventions for Patent Ductus Arteriosus of Preterm Infants

Abstract

Invasive interventions have been conducted in preterm infants with significant patent ductus arteriosus (PDA) when medical treatment has failed, and methods of invasive intervention have been reported. Surgical ligation via lateral thoracotomy has been a well-established procedure for decades. Recently, transcatheter occlusion has been safely and feasibly applied to the premature population. However, little research has been conducted on the benefits of transcatheter occlusion in very-low-birth-weight (VLBW) infants compared to surgical ligation. This study compared transcatheter and surgical techniques in VLBW infants in terms of short-term respiratory outcomes. The medical records of 401 VLBW infants admitted to a tertiary hospital between September 2014 and January 2019 were retrospectively reviewed. Patients who were diagnosed with a congenital anomaly, a chromosomal anomaly, or congenital heart disease, except for an inter-atrial shunt, were excluded. The perinatal conditions, neonatal morbidities, periprocedural vital signs, and respiratory support trajectories were compared between the transcatheter-treated and surgically ligated group. A total of 31 eligible VLBW infants received invasive intervention: 14 were treated with transcatheter occlusion (Group A), and 17 infants were treated with surgical ligation (Group B). Respiratory outcomes were not statistically significant between the two groups, despite Group A showing a trend toward early improvement in post-intervention respiratory trajectory. In this small case study, a different trend in post-intervention respiratory trajectories was observed. Future research with larger case numbers should be conducted to address our preliminary observations in more detail.

Transcatheter Closure vs. Surgical Ligation in Preterm Infants with Patent Ductus Arteriosus: A Systematic Review and Meta-Analysis

“…1A). Similarly, necrotising enterocolitis (NEC) was reported in 5 studies [14,15,19,27,28] and our study illustrated a comparable baseline characteristic between the TC (n = 31, 13.6%) and SL cohorts (n = 30, 11.6%) (OR = 1.22, 95% CI: 0.20, 7.33, I 2 = 80%) (Fig. 1B).…”

“…All 8 studies reported patient comorbidities in both groups (TC: n = 366, SL: n = 390) prior to the procedure. 2 studies [14,28] reported bronchopulmonary dysplasia (BPD) as a pre-procedural comorbidity, with the data showing no difference between the TC group (n = 60, 51.7%) and the SL group (n = 59, 48.4%) (OR = 1.21, 95% CI: 0.71, 2.08, I 2 = 0%) (Fig. 1A).…”

Massive Gastric Hemorrhage after Indomethacin Therapy: A Rare Presentation and Critical Management in an Extremely Preterm Infant

“…In preterm infants with pulmonary hemorrhage and hemodynamically significant PDA who are not able to undergo surgical ligation, some authors have reported transcatheter occlusion as a feasible and alternative approach [ 71 , 72 ]. Less invasive procedures, such as transcatheter closure, may be of use to this critical population [ 72 , 73 ].…”

Cardiovascular Intervention in Neonates Using an Umbilical Vein Approach

“…Transcatheter PDA occlusion in ELBW infants became technically feasible following the development of a new delivery sheath and device [25]. Recent data show a tendency toward early improvement in the pulmonary score of a transcatheter occlusion group of infants compared with the surgical ligation group [26]. Previously, our group successfully used the umbilical vein for transcatheter closure of the PDA in symptomatic premature infants weighing more than 478 g [8].…”