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Management and outcomes of concurrent patent ductus arteriosus and necrotising enterocolitis in preterm infants in a surgical neonatal intensive care unit
  1. A Stewart1,2,
  2. A Heuchan1,
  3. N Patel1,
  4. G Walker1
  1. 1Royal Hospital for Sick Children, Glasgow, UK
  2. 2Royal Brisbane and Women's Hospital, Brisbane, Australia

Abstract

Background Patent ductus arteriosus (PDA) and necrotising enterocolitis (NEC) are common complications of prematurity and important causes of morbidity and mortality. PDA is a risk factor for NEC. However, there is a lack of evidence to guide management approaches, including sequence of surgery, in patients with concurrent PDA and NEC.

Method We performed a retrospective audit of infants admitted to the Glasgow Royal Hospital for Sick Children with concurrent diagnoses of PDA and NEC between June 2005 and June 2010.

Results 16 preterm infants were identified (gestation 26 (24–30) weeks, birth weight 810 (625–1370) g). PDA ligation was performed in all but one case. NEC was conservatively managed in four patients. The remaining infants had separate surgical management of both PDA and NEC: seven had a laparotomy first and four underwent PDA ligation first. The laparotomy first group had a lower median birth weight and gestational age (25+4 weeks, 756 g vs 27 weeks, 1027 g), and a higher illness burden (inotrope and ventilation requirement and duration) immediately before and after their first surgical procedure. There were no significant differences in neurological, gastrointestinal and respiratory long-term outcomes. There were four deaths, all of which occurred in infants who underwent a laparotomy and PDA ligation.

Conclusions Although a laparotomy prior to PDA ligation approach was favoured in infants with a higher illness burden, there was no significant difference in outcomes between the study groups. Larger prospective studies are required to address the dilemma of surgical management of concurrent PDA and NEC.

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