Background There is a lack of standardised criteria for selecting patients for ligation of a patent ductus arteriosus. This may lead to delays in referring patients and inappropriate intervention for other patients. A neonatologist-led PDA ligation categorisation and triaging process was introduced in 2005 at a large quaternary hospital to streamline the admission process and enhance peri-operative care through use of Targeted Neonatal Echocardiography.
Objective To investigate the impact of a dedicated PDA ligation triaging system on referrals and quality indicators.
Methods A retrospective comparative analysis of two epochs [EP1 (2003–5) and EP2 (2010–12)] was conducted. All referrals for PDA ligation were evaluated for severity of pre-operative illness and morbidities, postoperative instability, length of post-operative stay and effectiveness of triaging system between the two epochs. The primary outcome was incidence of PDA ligations per year / per total number of live births < 30 weeks gestation. Secondary outcomes included procedural cancellation or delay, postoperative need for inotropes or cardiovascular support and oxygenation support.
Results A total of 198 babies [EP1(n = 117) vs EP2(n = 81)] had PDA ligations in two epochs. There was no difference in baseline demographics or pre-procedural neonatal morbidity between epochs. The incidence of PDA ligation was lower in the second epoch [EP 1: 117/1092 (10.7%) vs EP2: 81/1520 (5.3%)]. Although pre-procedural illness severity was greater in epoch II the incidence of post-ligation cardiac syndrome and recovery time were lower on babies <1000 g at surgery.
Conclusions The presence of a dedicated triaging and management system enhances the efficiency of the referral process through careful selection of patients for PDA ligation and optimises perioperative management.
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