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The incidence of patent ductus arteriosus and surgical ligation in babies less than 29+0 weeks gestation in a tertiary neonatal unit
  1. L Podugu,
  2. S V Rasiah
  1. Birmingham Women's Hospital, Birmingham, UK

Abstract

Background The incidence of patent ductus arteriosus (PDA) is inversely related to gestational age. Haemodynamically significant PDAs can be managed medically with either Indomethacin or Ibuprofen. Surgical ligation is usually reserved for recalcitrant PDAs in ventilator dependent babies.

Aim To review the incidence of PDA and the need for surgical ligation.

Methods The Badger electronic patient admission system was used to identify babies less than 29+0 weeks gestation in the last financial year (1 April 2009–31 March 2010). The unit echo reports were interrogated for their findings.

Results 123 babies less than 29+0 weeks gestation were admitted during this period. Echocardiogram was performed in 82 (66%) of babies based on clinical findings. PDA was diagnosed in 74 babies (60%). Outcome was not known in 5 babies (transferred out of the region). Of the 69 babies, 20 (28.9%) were closed either spontaneously or with Indomethacin, 22 (31.8%) had residual murmur, 18 (26%) died and 9 (13%) needed surgical ligation. Indomethacin was used in 29 babies, resulting in successful closure of duct in 18 (62%). Surgical ligation was performed at a median age of 31 days (range 19–91) and resulted in successful extubation in 88% (8/9) babies without steroids. Average duration of ventilation in babies who underwent surgical ligation was 24 days (14–36 days).

Conclusion PDAs in extremely preterm babies can be recalcitrant to medical intervention and require surgical ligation. Early consideration for PDA ligation might reduce ventilatory days and the need for postnatal steroids.

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