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Bedside patent ductus arteriosus ligatıon in low-birth-weight premature infants

Year 2018, Volume: 10 Issue: 3, 312 - 316, 30.09.2018
https://doi.org/10.21601/ortadogutipdergisi.435510

Abstract

Aim: The
aim of our study is to demonstrate that the patent ductus arteriosus (PDA) can
be safely ligated in low birth weight and premature infants in intensive care
units after the minimum standarts of intensive care units are determined in our
country.

Material and Method: Sixteen
patients who underwent operation due to patent ductus arteriosus (PDA) in
neonatal intensive care unit between 2011 and 2017 were evaluated
retrospectively for gestational age, age at operation date, body weight at
operation, duration of mechanical ventilation, intensive care unit stay, and
preoperative and postoperative PDA complications were evaluated.

Results: A
total of 16 patients were included in the study, including six girls and ten
boys. All patients received medical treatment with cyclooxygenase inhibitors 2
times for PDA closure prior to surgery.The surgical ligation decision was made
because the PDA did not close. Birth weight of the patients was 1125.9
±254 gr mean gestational age was 26,6±1,4 weeks. Mean intensive care unit stay
was 72.6
±48.9 days and
mechanical ventilation duration was 28.5
±30.5
days. Postoperative mortality developed in two patients. Trisomy 18, a
24-week-old woman with syndrome of 542 g, died on the postoperative day 126 due
to severe heart and respiratory failure. The other patient who developed
mortality was born at 28 weeks and 914 gr. She died due to sepsis at 21 days
postoperatively.







Conclusion: In
premature and low birth weight infants PDA is a frequent cause of significant
mortality and morbidity. There is a 50-60% chance of closure with
cyclooxygenase inhibitors. Early surgical ligation is associated with decreased
mechanical ventilation duration and less complication. In addition, in neonatal
intensive care units conforming to developed standards, patients can be
operated safely while preserving risks related to transfer.

References

  • 1- Avsar MK, Demir T, Celiksular C, Zeybek C. Bedside PDA ligation in premature infants less than 28 weeks and 1000 grams. Journal of cardiothoracic surgery, 2016; 11(1), 146.
  • 2- Mercanti I, Boubred F, Simeoni U. Therapeutic closure of the ductus arteriosus: benefits and limitations. J Matern Fetal Neonatal Med. 2009;22: 14–20.
  • 3- Lago P, Bettiol T, Salvadori S, et al. Safety and efficacy of ibuprofen versus indomethacin in preterm infants treated for patent ductus arteriosus: a randomised controlled trial. Eur J Pediatr. 2002:161:202–7.
  • 4- Sekar KC, Corff KE. Treatment of patent ductus arteriosus: indomethacin or ibuprofen? J Perinatol. 2008;28:60–2.
  • 5- Quek SC, Santos D, Rajgor DD, Yu F, Grignani R. Comparison of outcomes and costs of transcatheter therapeutic intervention and surgical ligation for the treatment of Patent Ductus Arteriosus. Ann Acad Med Singapore. 2016; 45(6):256–8.
  • 6- Ko YC, Chang CI, Chiu IS, Chen YS, Huang SC, Hsieh WS. Surgical ligation of patent ductus arteriosus in very-low-birth-weight premature infants in the neonatal intensive care unit. J Formos Med Assoc. 2009;108(1):69–71.
  • 7- Malviya MN, Ohlsson A, Shah SS. Surgical versus medical treatment with cyclooxygenase inhibitors for symptomatic patent ductus arteriosus in preterm infants. Cochrane Database Syst Rev. 2013;28(3):CD0039.
  • 8- Trus T, Winthrop AL, Pipe S, Shah J, Langer JC, Lau GY. Optimal management of patent ductus arteriosus in the neonate weighing less than 800 g. J Pediatr Surg. 1993;28: 1137–9.
  • 9- Grosfeld JL, Chaet M, Molinari F, et al. Increased risk of necrotizing enterocolitis in premature infants with patent ductus arteriosus treated with indomethacin. Ann Surg. 1996;224:350–7.
  • 10- Cotton RB, Stahlman MT, Bender HW, Graham TP, Catterton WZ, Kovar I. Randomized trial of early closure of symptomatic patent ductus arteriosus in small preterm infants. J Pediatr 1978;93:647-51.
  • 11- Hsiao CC, Wung JT, Tsao LY, Chang WC. Early or late surgical ligation of medical refractory patent ductus arteriosus in premature infants. J Formos Med Assoc. 2009;108(1):72–77
  • 12- Metin K, Maltepe F, Kır M, et al. Ligation of patent ductus arteriosus in low birth weight premature infants: timing for intervention and effectiveness of bed-side surgery. J Cardiothorac Surg. 2012;7:129.
  • 13- Brooks JM, Travadi JN, Patole SK, Doherty DA, Simmer K. Is surgical ligation of patent ductus arteriosus necessary? The Western Australian experience of conservative management. Arch Dis Child Fetal Neonatal Ed. 2005;90(3):F235–F239

Düşük doğum ağırlıklı prematür infantlarda yatak başı patent duktus arteriozus ligasyonu

Year 2018, Volume: 10 Issue: 3, 312 - 316, 30.09.2018
https://doi.org/10.21601/ortadogutipdergisi.435510

Abstract

Amaç:
Ülkemizde
yoğun bakım ünitelerinin asgari standartlarının belirlenmesiyle beraber gelişmiş
standartlara uygun olarak hizmet veren yenidoğan yoğun bakım ünitelerinde düşük
doğum ağırlıklı ve prematüre infantlarda patent duktus arteriozusun (PDA)
güvenli bir şekilde ligasyonunun yapılabileceğinin gösterilmesi.

Gereç ve Yöntem: Yenidoğan
yoğun bakım ünitesinde 2011-2017 yılları arasında patent duktus arteriozus
nedeniyle ameliyat olan 16 hastanın gestasyonel yaşı, ameliyat tarihindeki
yaşı, ameliyat tarihindeki vücut ağırlığı, mekanik ventilasyon süresi, yoğun
bakım kalış süreleri ile ameliyat öncesi ve sonrası PDA nedeniyle gelişmiş olan
komplikasyonları retrospektif olarak değerlendirildi.

Bulgular: Altı
kız, 10 erkek olmak üzere toplam 16 hasta çalışmaya dahil edildi. Hastaların
tamamı ameliyat öncesi PDA kapanması için 2 kür siklooksinez inhibitörleri ile
medikal tedavi aldı. PDA kapanmadığı için cerrahi ligasyon kararı alındı. Hastaların
doğum ağırlığı 1125,9
±254
gr ortalama gestasyonel yaşları 26,6
±1,4
hafta idi. Ortalama yoğun bakımda kalış süreleri 72,6
±48,9 gün mekanik ventilasyon süresi ise 28,5±30,5 gündü.

Postoperatif
dönemde iki hastada mortalite gelişti. Trizomi 18 sendromu olan 24 haftalık ve
542 gr olan olarak doğan hasta postoperatif 126. günde ağır kalp ve solunum
yetmezliği nedeniyle kaybedildi. Mortalite gelişen diğer hasta ise 28 haftalık
ve 914 gr olarak doğmuştu. Ameliyat sonrası 21. günde sepsis nedeniyle
kaybedildi.









Sonuç: Prematüre
ve düşük doğum ağırlıklı infantlarda PDA sık görülen ve önemli bir mortalite ve
morbidite nedenidir. Siklooksijenaz inhibitörleri ile %50-60 oranında kapanma
ihtimali bulunmaktadır. Erken dönem uygulanan cerrahi ligasyon mekanik
ventilasyon süresinde azalma ve daha az komplikasyon gelişimi ile ilişkilidir.
Ayrıca gelişmiş standartlara uygun yenidoğan yoğun bakım ünitelerinde hastalar
transferden kaynaklanacak risklerden korunarak güvenli bir şekilde ameliyat
edilebilmektedir.

References

  • 1- Avsar MK, Demir T, Celiksular C, Zeybek C. Bedside PDA ligation in premature infants less than 28 weeks and 1000 grams. Journal of cardiothoracic surgery, 2016; 11(1), 146.
  • 2- Mercanti I, Boubred F, Simeoni U. Therapeutic closure of the ductus arteriosus: benefits and limitations. J Matern Fetal Neonatal Med. 2009;22: 14–20.
  • 3- Lago P, Bettiol T, Salvadori S, et al. Safety and efficacy of ibuprofen versus indomethacin in preterm infants treated for patent ductus arteriosus: a randomised controlled trial. Eur J Pediatr. 2002:161:202–7.
  • 4- Sekar KC, Corff KE. Treatment of patent ductus arteriosus: indomethacin or ibuprofen? J Perinatol. 2008;28:60–2.
  • 5- Quek SC, Santos D, Rajgor DD, Yu F, Grignani R. Comparison of outcomes and costs of transcatheter therapeutic intervention and surgical ligation for the treatment of Patent Ductus Arteriosus. Ann Acad Med Singapore. 2016; 45(6):256–8.
  • 6- Ko YC, Chang CI, Chiu IS, Chen YS, Huang SC, Hsieh WS. Surgical ligation of patent ductus arteriosus in very-low-birth-weight premature infants in the neonatal intensive care unit. J Formos Med Assoc. 2009;108(1):69–71.
  • 7- Malviya MN, Ohlsson A, Shah SS. Surgical versus medical treatment with cyclooxygenase inhibitors for symptomatic patent ductus arteriosus in preterm infants. Cochrane Database Syst Rev. 2013;28(3):CD0039.
  • 8- Trus T, Winthrop AL, Pipe S, Shah J, Langer JC, Lau GY. Optimal management of patent ductus arteriosus in the neonate weighing less than 800 g. J Pediatr Surg. 1993;28: 1137–9.
  • 9- Grosfeld JL, Chaet M, Molinari F, et al. Increased risk of necrotizing enterocolitis in premature infants with patent ductus arteriosus treated with indomethacin. Ann Surg. 1996;224:350–7.
  • 10- Cotton RB, Stahlman MT, Bender HW, Graham TP, Catterton WZ, Kovar I. Randomized trial of early closure of symptomatic patent ductus arteriosus in small preterm infants. J Pediatr 1978;93:647-51.
  • 11- Hsiao CC, Wung JT, Tsao LY, Chang WC. Early or late surgical ligation of medical refractory patent ductus arteriosus in premature infants. J Formos Med Assoc. 2009;108(1):72–77
  • 12- Metin K, Maltepe F, Kır M, et al. Ligation of patent ductus arteriosus in low birth weight premature infants: timing for intervention and effectiveness of bed-side surgery. J Cardiothorac Surg. 2012;7:129.
  • 13- Brooks JM, Travadi JN, Patole SK, Doherty DA, Simmer K. Is surgical ligation of patent ductus arteriosus necessary? The Western Australian experience of conservative management. Arch Dis Child Fetal Neonatal Ed. 2005;90(3):F235–F239
There are 13 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Original article
Authors

Murat Koç 0000-0003-4555-2151

Publication Date September 30, 2018
Published in Issue Year 2018 Volume: 10 Issue: 3

Cite

Vancouver Koç M. Düşük doğum ağırlıklı prematür infantlarda yatak başı patent duktus arteriozus ligasyonu. omj. 2018;10(3):312-6.

e-ISSN: 2548-0251

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