Bedside Surgical Ligation of Patent Ductus Arteriosus in Very-low-birth-weight Premature Infants in the Neonatal Intensive Care Unit Outcome

Abstract

Aim: The aim of this study is to retrospectively evaluate the results of patients who underwent bedside surgical PDA ligation that did not respond to the hemodynamic significant patent ductus arteriosus HAPDA medical closure therapy.Material And Methods: Twelve infants diagnosed with HAPDA in the Neonatal Intensive Care Unit and treated with bedside surgical pda ligation were included in the study. Demographic features, pre- and postoperative respiratory support, oxygen demand and duration, intraventricular hemorrhage, bronchopulmonary dysplasia, hospital stay duration and mortality data were recorded.Results: The mean age at surgery was 38 19-78 days. About 40 days after the operation one patient 8% was lost syndromic infant and 11 patients were discharged. There was no complication due to surgical treatment in our patients. All patients who were discharged were saved from oxygen after 15 days 19-60 days postoperatively.Conclusion: PDA ligation in bedside surgery should be kept in mind as a safe method in HAPDA patients who do not respond to medical treatment.

Keywords

• Premature,PDA,surgical ligation

Yenidoğan Yoğun Bakım Ünitesinde Çok Düşük Doğum Ağırlıklı Prematüre Bebeklerde Yatakbaşı Cerrahi Patent Duktus Arteriosusun Ligasyonu Sonuçlarımız

Abstract

Amaç: Hemodinamik anlamlı patent duktus arteriozus HAPDA medikal kapatma tedavisine cevap vermeyen yatak başı cerrahi PDA ligasyon yapılan hastaların sonuçlarının retrospektif olarak değerlendirilmesi amaçlanmıştır.Gereç ve Yöntemler: Yenidoğan Yoğun Bakım Ünitesinde HAPDA tanısı alan ve yatakbaşı cerrahi PDA ligasyonu uygulanan 12 bebek çalışmaya dahil edildi. Demografik özellikler, ameliyat öncesi ve sonrası solunum desteği, oksijen ihtiyacı ve süresi, intraventriküler kanama, bronkopulmoner displazi, hastanede kalış süresi ve mortalite verileri kaydedildi.Bulgular: Ameliyat edilme yaşı postnatal ortalama 40 19-60 gün idi. Ameliyat yaklaşık 40 gün sonra bir hasta % 8 kaybedilirken sendromik infant , 11 hasta taburcu edilebildi. Hastalarımızda izlemde cerrahi uygulamaya bağlı komplikasyon gelişmedi. Tüm hastalar oksijensiz taburcu edil.Sonuç: Yatakbaşı cerrahi PDA ligasyonu medikal tedaviye cevap vermeyen HAPDA’lı olgularda güvenli bir yöntem olarak akılda tutulmalıdır.

Keywords

• Prematüre,PDA,yatak başı cerrahi ligasyon

References

1. Oncel MY, Erdeve O. Oral medications regarding their safety and effica- cy in the management of patent ductus arteriosus. World J Clin Pediatr. 2016;5(1):75-81.
2. Prescott S, Keim-Malpass J. Patent Ductus Arteriosus in the Pre- term Infant: Diagnostic and Treatment Options. Adv Neonatal Care. 2017;17(1):10-8.
3. Lehenbauer DG, Fraser CD 3rd, Crawford TC, Hibino N, Aucott S, Grimm JC et al. Surgical Closure of Patent Ductus Arteriosus in Premature Ne- onates Weighing Less Than 1,000 grams: Contemporary Outcomes. W World J Pediatr Congenit Heart Surg.. 2018;9(4):419-23.
4. Hagadorn JI, Bennett MV, Brownell EA, Payton KSE, Benitz WE, Lee HC. Covariation of Neonatal Intensive Care Unit-Level Patent Ductus Arteri- osus Management and In-Neonatal Intensive Care Unit Outcomes Fol- lowing Preterm Birth. J Pediatr. 2018;203:225- 33
5. Mitra S, Ronnestad A, Holmstrom H. Management of patent ductus ar- teriosus in preterm infants--where do we stand? Congenit Heart Dis. 2013;8(6):500-12.
6. Dani C. New therapeutic strategies for the treatment of patent ductus ar- teriosus in preterm infants. J Matern Fetal Neonatal Med. 2011;24 Suppl 3:5-6.
7. Raval MV, Laughon MM, Bose CL, Phillips JD. Patent ductus arteriosus ligation in premature infants: who really benefits, and at what cost? J J Pediatr Surg. 2007;42(1):69- 75
8. Truog WE, Jackson JC, Badura RJ, Sorensen GK, Murphy JH, Woodrum DE. Bronchopulmonary dysplasia and pulmonary insufficiency of prema- turity. Lack of correlation of outcome with gas exchange abnormalities at 1 month of age. Am J Dis Child. 1985;139(4):351-4.

9. Tantraworasin A, Woragidpoonpol S, Chuaratanapong S, Sittiwangkul R, Chittawatanarat K. Timing of surgical closure of patent ductus arteriosus in preterm neonates? Asian Cardiovasc Thorac Ann.2012;20(1):12-8.
10. Jaillard S, Larrue B, Rakza T, Magnenant E, Warembourg H, Storme L. Consequences of delayed surgical closure of patent ductus arteriosus in very premature infants. Ann Thorac Surg. 2006;81(1):231-4.
11. Vida VL, Lago P, Salvatori S, Boccuzzo G, Padalino MA, Milanesi O, et al. Is there an optimal timing for surgical ligation of patent ductus arteriosus in preterm infants? Ann Thorac Surg. 2009;87(5):1509-15.
12. Ko YC, Chang CI, Chiu IS, Chen YS, Huang SC, Hsieh WS. Surgical ligati- on 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.
13. Stoller JZ, Demauro SB, Dagle JM, Reese J. Current Perspectives on Pat- hobiology of the Ductus Arteriosus. J Clin Exp Cardiolog. 2012;8(1). pii: S8-001
14. Jain A, Shah PS. Diagnosis, Evaluation, and Management of Patent Duc- tus Arteriosus in Preterm Neonates. JAMA pediatrics. 2015;169(9):863- 72.
15. Evans N, Moorcraft J. Effect of patency of the ductus arteriosus on blo- od pressure in very preterm infants. Arch Dis Child. 1992;67(10 Spec No):1169-73.
16. Mohamed MA, Aly H. Transport of premature infants is associated with increased risk for intraventricular haemorrhage. Arch Dis Child Fetal Neo- natal Ed. 2010;95(6):F403-7.
17. Gleissner M, Jorch G, Avenarius S. Risk factors for intraventricular he- morrhage in a birth cohort of 3721 premature infants. J Perinat Med. 2000;28(2):104-10.
18. Gould DS, Montenegro LM, Gaynor JW, Lacy SP, Ittenbach R, Stephens P, et al. A comparison of on-site and off-site patent ductus arteriosus ligation in premature infants. Pediatrics. 2003;112(6 Pt 1):1298-301.
19. Stark AR. Levels of neonatal care. Pediatrics. 2004;114(5):1341-7.
20. Anand KJ, Sippell WG, Aynsley-Green A. Randomised trial of fentanyl anaesthesia in preterm babies undergoing surgery: effects on the stress response. Lancet. 1987;1(8527):243-8.
21. Moin F, Kennedy KA, Moya FR. Risk factors predicting vasopressor use after patent ductus arteriosus ligation. Am J Perinatol. 2003;20(6):313- 20.
22. Smith ME, King JD, Elsherif A, Muntz HR, Park AH, Kouretas PC. Should all newborns who undergo patent ductus arteriosus ligation be examined for vocal fold mobility? The Laryngoscope. 2009;119(8):1606-9.
23. Janvier A, Martinez JL, Barrington K, Lavoie J. Anesthetic technique and postoperative outcome in preterm infants undergoing PDA closure. J Pe- rinatol. 2010;30(10):677-82.
24. Keskin g, Akın M, Şenaylı Y, Saydam S, özmert S, Sever F, Özmert S et al. Anesthesıa management of 775 grams premature patient during pda ligation-a case report. J Contemp Med 2016;6(1):47-50.