Risk Factors Predicting Vasopressor Use After Patent Ductus Arteriosus Ligation

 

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ABSTRACT

Ligation of the patent ductus arteriosus (PDA) is sometimes complicated by postoperative hypotension requiring vasopressor(s). It is unclear which infants are at risk for this complication. We conducted a retrospective and prospective cohort study to identify risk factors predicting vasopressor use after PDA ligation. Our patients were infants < 37 weeks of gestation who underwent PDA ligation. The primary outcome was the use of vasopressor(s) within 72 hours after PDA ligation, defined as beginning vasopressor(s) or increasing the dose of vasopressor(s). Thirty-two of 100 (32%) study infants required vasopressor(s) after PDA ligation. Infants who had lower birth weights, lower gestational ages, higher ventilator support, or whose mothers had received antenatal steroids had a higher risk of vasopressor use. Infants who required vasopressor(s) were at increased risk of dying before 36 weeks postmenstrual age. Lower birth weight, lower gestational age, and higher respiratory support define a high-risk subgroup of patients in whom the prophylactic administration of vasopressor(s) could be studied.

REFERENCES

• 1 Kimball T R, Ralston M A, Khoury P, Crump R G, Cho F S, Reuter J H. Effect of ligation of patent ductus arteriosus on left ventricular performance and its determinants in premature neonates.  J Am Coll Cardiol . 1996;  27 193-197
  PubMedGoogle Scholar
• 2 Taylor A F, Morrow W R, Lally K P, Kinsella J P, Gerstmann D R, Delemos R A. Left ventricular dysfunction following ligation of the ductus arteriosus in the preterm baboon.  J Surg Res . 1990;  48 590-596.
  PubMedGoogle Scholar
• 3 Papile L A, Krause-Steinrauf H, Wright L L. et al . Identification of very low birth weight infants (VLBW) risk for chronic lung disease (CLD).  Pediatr Res . 1994;  35 246A
  PubMedGoogle Scholar
• 4 Takahashi Y, Harada K, Tamura M, Takada G. Left ventricular preload reserve in preterm infants with patent ductus arteriosus.  Arch Dis Child . 1994;  71 F118-F21.
  PubMedGoogle Scholar
• 5 Takahashi Y, Harada K, Ishida A, Tamura M, Tanaka T, Takada G. Changes in left ventricular volume and systolic function before and after the closure of ductus arteriosus in full-term infants.  Early Hum Dev . 1996;  44 77-85
  CrossrefPubMedGoogle Scholar
• 6 Crowley P. Prophylactic corticosteroids for preterm birth (Cochrane Review). In: The Cochrane Library, Issue 2 Oxford: Update Software 2001
  Google Scholar
• 7 Karlsson R, Kallio J, Scheinin M, Kero P. Antenatal and early postnatal dexamethasone treatment decreases cortisol secretion in preterm infants.  Horm Res . 2000;  53 170-176
  CrossrefPubMedGoogle Scholar
• 8 Ng P C, Wong G W, Lam C W. et al . Effect of multiple courses of antenatal corticosteroids on pituitary-adrenal function in preterm infants.  Arch Dis Child Fetal Neonatal Ed . 1999;  80 F213-F216
  PubMedGoogle Scholar
• 9 Halliday H L, Ehrenkranz R A. Moderately early (7-14 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants (Cochrane Review). In: The Cochrane Library, Issue 2 Oxford: Update Software 2001
  Google Scholar
• 10 Yunis K A, Bitar F F, Hayek P, Mroueh S M, Mikati M. Transient hypertrophic cardiomyopathy in the newborn following multiple doses of antenatal corticosteroids.  Am J Perinatol . 1999;  16 17-21
  PubMedGoogle Scholar
• 11 Zaugg M, Jamali N Z, Lucchinetti E. et al . Anabolic-androgenic steroids induce apoptotic cell death in adult rat ventricular myocytes.  J Cell Physiol . 2001;  187 90-95
  CrossrefPubMedGoogle Scholar