Outcomes following the surgical ligation of the patent ductus arteriosus in premature infants in Scotland

Anne Marie Heuchan, Lindsey Hunter, David Young

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Aims to determine morbidity, mortality and associated risk factors following patent ductus arteriosus (PDA) ligation in premature infants. Retrospective case note audit of premature infants referred to a national paediatric cardiothoracic surgical service (2001–2007) with univariate and multivariate analysis of potential risk factors for mortality and morbidity. 125 infants were enrolled (median gestational age 26 weeks (IQR 25–27 weeks), median birth weight 840 g (IQR 730–1035 g)). Referral characteristics were median LA:Ao 1.8 (IQR 1.5–2.0), 80% ventilated, 18.4% continuous positive airway pressure, 70% diuretics and 58% prior treatment with cyclooxygenase inhibitors (COIs). Median age at PDA ligation was 31 days (IQR 25–41 days). Postoperative characteristics were median time to extubation 5 days (IQR 3–10 days), 36.0% corticosteroids, 46.8% domiciliary oxygen and 4.8% vocal cord palsy. The 30-day and 1-year mortality rates 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 and fractional inspired oxygen (FiO2)>60% were significantly associated with 30-day mortality. FiO2, ventilation, lack of prior COIs and postoperative corticosteroids were significantly associated with 1-year mortality. Preoperative FiO2>40% and lack of prior COIs retained independent significance for death at 1 year. PDA ligation is well tolerated, with evidence of early benefit. The incidence of neurodisability or death from BPD at 1 year remains high. Increasing preoperative FiO2 and lack of prior treatment with COIs are associated with increased mortality at 1 year.

LanguageEnglish
Pages39-44
Number of pages6
JournalArchives of Disease in Childhood Fetal and Neonatal Edition
Volume97
Issue number1
Early online date17 Aug 2011
DOIs
Publication statusPublished - 2012

Fingerprint

Patent Ductus Arteriosus
Scotland
Premature Infants
Ligation
Cyclooxygenase Inhibitors
Mortality
Bronchopulmonary Dysplasia
Adrenal Cortex Hormones
Oxygen
Morbidity
Vocal Cord Paralysis
Continuous Positive Airway Pressure
Diuretics
Birth Weight
Gestational Age
Ventilation
Survivors
Referral and Consultation
Multivariate Analysis
Pediatrics

Keywords

  • PDA ligation
  • surgical ligation
  • premature infants
  • pediatrics
  • mathematical analysis

Cite this

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title = "Outcomes following the surgical ligation of the patent ductus arteriosus in premature infants in Scotland",
abstract = "Aims to determine morbidity, mortality and associated risk factors following patent ductus arteriosus (PDA) ligation in premature infants. Retrospective case note audit of premature infants referred to a national paediatric cardiothoracic surgical service (2001–2007) with univariate and multivariate analysis of potential risk factors for mortality and morbidity. 125 infants were enrolled (median gestational age 26 weeks (IQR 25–27 weeks), median birth weight 840 g (IQR 730–1035 g)). Referral characteristics were median LA:Ao 1.8 (IQR 1.5–2.0), 80{\%} ventilated, 18.4{\%} continuous positive airway pressure, 70{\%} diuretics and 58{\%} prior treatment with cyclooxygenase inhibitors (COIs). Median age at PDA ligation was 31 days (IQR 25–41 days). Postoperative characteristics were median time to extubation 5 days (IQR 3–10 days), 36.0{\%} corticosteroids, 46.8{\%} domiciliary oxygen and 4.8{\%} vocal cord palsy. The 30-day and 1-year mortality rates 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 and fractional inspired oxygen (FiO2)>60{\%} were significantly associated with 30-day mortality. FiO2, ventilation, lack of prior COIs and postoperative corticosteroids were significantly associated with 1-year mortality. Preoperative FiO2>40{\%} and lack of prior COIs retained independent significance for death at 1 year. PDA ligation is well tolerated, with evidence of early benefit. The incidence of neurodisability or death from BPD at 1 year remains high. Increasing preoperative FiO2 and lack of prior treatment with COIs are associated with increased mortality at 1 year.",
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Outcomes following the surgical ligation of the patent ductus arteriosus in premature infants in Scotland. / Heuchan, Anne Marie; Hunter, Lindsey; Young, David.

In: Archives of Disease in Childhood Fetal and Neonatal Edition, Vol. 97, No. 1, 2012, p. 39-44.

Research output: Contribution to journalArticle

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