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Outcome of patent ductus arteriosus ligation in premature infants in the East of England: a prospective cohort study

Published online by Cambridge University Press:  20 November 2012

Sok-Leng Kang ,
Salehuddin Samsudin ,
Minju Kuruvilla ,
Anshoo Dhelaria ,
Sue Kent  and
Wilfred A. Kelsall
Sok-Leng Kang
Affiliation:
Paediatric Cardiology, University Hospital of Wales, Cardiff, United Kingdom
Salehuddin Samsudin
Affiliation:
Neonatal Intensive Care Unit, Royal Preston Hospital, Preston, United Kingdom
Minju Kuruvilla
Affiliation:
Neonatal Intensive Care Unit, Saint Mary's Hospital, Central Manchester University Hospitals, Manchester, United Kingdom
Anshoo Dhelaria
Affiliation:
Paediatric Department, East and North Hertfordshire Hospital, Stevenage, United Kingdom
Sue Kent
Affiliation:
Neonatal Intensive Care Unit, Addenbrookes Hospital, Cambridge University Foundation Trust, Cambridge, United Kingdom
Wilfred A. Kelsall*
Affiliation:
Neonatal Intensive Care Unit, Addenbrookes Hospital, Cambridge University Foundation Trust, Cambridge, United Kingdom
*
Correspondence to: Dr W. A. Kelsall, BSc, MB, BChir, FRCPCH, Neonatal Intensive Care Unit, Box 226, Addenbrookes Hospital, Hills Road, Cambridge CB2 2QQ, United Kingdom. Tel: +01223256941; Fax: +01223217064; E-mail: wilf.kelsall@addenbrookes.nhs.uk
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Abstract

Background

Surgical ligation of patent ductus arteriosus is considered when medical treatment fails or is contraindicated. This study aims to determine the mortality and morbidity of preterm neonates referred for patent ductus arteriosus ligation.

Methods

A prospective study was conducted in the East of England to follow the outcome of premature infants under 37 weeks’ gestation undergoing patent ductus arteriosus ligation. A standardised proforma was used to collect information before and after the procedure.

Results

A total of 102 premature infants were recruited, and patent ductus arteriosus ligation was performed in 92. Surgical complications occurred in 8.7% (8/92), which included pneumothorax (5/8), recurrent laryngeal nerve palsy (2/8), and chylothorax (1/8). Morbidity outcome data were not available for all infants. The incidence of chronic lung disease was 88% (88/99); intraventricular haemorrhage was 49% (49/100); necrotising enterocolitis 39% (39/99), and retinopathy of prematurity 42% (41/97). The overall mortality rate in our study was 7.8% (8/102). Mortality rate in infants who had patent ductus arteriosus ligation was 4.3% (4/92). The 30-day survival rate after ligation was 99% (91/92). Beyond 30 days post-ligation, three infants died from other causes that were not directly related to surgery.

Conclusion

Patent ductus arteriosus ligation in premature infants is associated with low mortality and complication rates; however, there is a high incidence of neonatal morbidity. Surgical capacity for patent ductus arteriosus ligation needs to be carefully planned nationally as the duration of “waiting time” and transport to another surgical centre could adversely affect outcomes in this high-risk population.

Keywords

Patent ductus arteriosusligationneonatemortalitymorbidity
Type
Original Articles
Information
Cardiology in the Young , Volume 23 , Issue 5 , October 2013 , pp. 711 - 716
Copyright
Copyright © Cambridge University Press 2012 

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