Rf58 Patent Ductus Arteriosus in Early Preterms: Sicilian and Calabrian on Site Experience

Abstract

Introduction: The selection of extremely preterm infants with persistent patent ductus arteriosus (PDA) for surgical ligation after the failure of pharmacologic closure remains controversial in neonatology. No randomized clinical trial has examined the efficacy of surgery compared with conservative management among infants with persistent hemodynamically significant PDA after nonsteroidal anti-inflammatory drug treatment. Although surgical closure definitely closes a persistent PDA, promotes early extubation and decreases the mortality rate, it is also associated with short-term adverse events, including post-PDA ligation cardiac syndrome, vocal cord paralysis, chylothorax, and pneumothorax. We report our interregional experience based on a 24 h dedicated “onsite team” that performs surgical procedures in regional NICU. Methods: As a part of the agreement between the “Bambino Gesù” Pediatric Hospital in Rome and the Sicily Health Region Government the Centro Cardiologico Pediatrico del Mediterraneo, became the only center of reference for the diagnosis and treatment of congenital heart disease in Sicily. Due to the extent of the territory and the extreme fragility of the preterm infant, surgical ligation of the PDA was conducted by a dedicated team, consisting of a cardiac surgeon, anesthetist and two operating room nurses, directly at the bedside in NICU. From May 2011 to May 2018, 78 on-site procedures were performed. Median gestational age was 26 weeks (range 24–32), median weight at birth 800 grams (range 570–1380), median weight at surgery 1000 grams (range 540–1600) with 62.3% of patients weighing less than 900 grams. All infants were treated with ligation when indomethacin or pacetamol failed or was contraindicated. In our population 56% attempted closure with Pedea, 12% with paracetamol. In the remaining cases, the pharmacological treatment was contraindicated due to the presence of comorbidity (for example III-IV grade cerebral hemorrhage, renal or hepatic insufficiency). Results: 75% of treated patients have been discharged from the hospital and is still in follow up. No short-term adverse events were registered. Conclusion: in our experience we confirm that such an approach represent a valid and safe option for the baby and the whole medical team involved in medical and surgical procedure.