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1 Year outcomes following surgical ligation of the patent ductus arteriosus in premature infants in scotland
  1. A M Heuchan1,
  2. L Hunter1,
  3. D Young2
  1. 1Royal Hospital for Sick Children, Glasgow, UK
  2. 2University of Strathclyde, Glasgow, UK

Abstract

Objective Analysis of morbidity, mortality and associated risk factors following ligation of the patent ductus arteriosus (PDA) in premature infants.

Methods Retrospective case note audit of premature infants referred to a national paediatric cardiothoracic surgical service (2001–2007).

Results The study included 125 infants, median gestational age of 26 weeks (IQR 25–27 weeks) and median birth weight of 840 g (IQR 730–1035 g). Referral characteristics included median LA:Ao 1.8 (IQR 1.5–2.0), ventilation (80%), CPAP (18.4%), diuretics (70%) and 58% treated with cyclo-oxygenase inhibitors (COIs). The median age at PDA ligation was 31 days (IQR 25–41 days). Post-operative characteristics included time to extubation 5 days (IQR 3–10 days), 36% required corticosteroids, 46.8% domiciliary oxygen and 4.8% vocal cord palsy. Mortality rates at 30 days and 1 year were 4.8% and 12.8%, respectively, with neurodisability in 32% of survivors. All deaths occurred in the ventilated group and were mainly attributable to bronchopulmonary dysplasia (BPD). Gestation was significantly associated with early death (<30 days). FiO2, ventilation, lack of prior COIs and post-operative corticosteroids were significantly associated with death by 1 year. Pre-operative FiO2 >40% and lack of prior COIs retained independent significance for death at 1 year post-ligation.

Conclusions PDA ligation is well tolerated, with evidence of early benefit. The incidence of neurodisability or death from BPD at 1 year remains high. Increasing pre-operative FiO2 and lack of prior treatment with COIs are associated with an increased risk of death at 1 year.

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