213 - Reduced Morbidity With Early Surgical Ligation of Patent Ductus Arteriosus in Extremely Low Birth Weight Infants: A Retrospective Single-Center Study
Saturday, April 29, 2023
3:30 PM – 6:00 PM ET
Poster Number: 213 Publication Number: 213.203
Katherine A. Loeffler, University of Oklahoma College of Medicine, Edmond, OK, United States; Matthew D. Campbell, Oklahoma Childrens Hospital at OU Health, Edmond, OK, United States; Shashank Behere, OUHSC, Oklahoma City, OK, United States; Patricia K. Williams, Oklahoma Childrens Hospital at OU Health, Oklahoma City, OK, United States
Sudent University of Oklahoma College of Medicine Edmond, Oklahoma, United States
Background: Patent ductus arteriosus (PDA) is a prevalent issue among premature neonates, especially those born at extremely low birth weight (ELBW). A persistent PDA in ELBW neonates may lead to numerous pulmonary and systemic complications and can significantly contribute to hospital morbidity. However, the ideal timing of surgical ligation (SL) of PDA within this cohort remains disputed. Objective: The purpose of this study was to assess whether PDA SL by 30 days of life (DOL) was associated with decreased mortality, length of mechanical ventilation (MV), neonatal intensive care unit (NICU) length of stay (LOS), rates of tracheostomy during hospital stay, and pulmonary vasodilator or supplemental oxygen use at discharge in ELBW infants who were diagnosed with a hemodynamically significant (HS) PDA. Design/Methods: This study retrospectively looked at the outcomes of patients with HS PDA who underwent SL at The Children’s Hospital of Oklahoma between January 2017 and August 2022. Excluding patients with congenital heart disease and those transferred to an outside hospital prior to discharge, a total of 60 neonates were identified who received SL prior to NICU discharge. Of these, 43 (71.7%) neonates were identified with birth weight less than 1000 grams. Patients were further stratified into 2 groups: early ligation (EL, surgery occurring at or before 30 DOL, n=9 [20.9%]) and late ligation (LL, surgery occurring after 30 DOL, n=34 [79.1%]). Outcome measures included mortality, NICU LOS, total days of MV, days of MV after surgery, tracheostomy during hospital stay, weight at discharge, and pulmonary vasodilator or supplemental oxygen use at discharge. Results: Demographic and pre-ligation clinical characteristics did not differ significantly between the 2 groups; however, as expected, weight at procedure was lower in the EL group compared to LL group (p< 0.05). The EL group vs the LL group experienced significantly less days of MV (mean of 43.9 days [8.4-96.2] vs. 97.2 days [70.3-124.2], p< 0.05) and were younger at discharge (mean of 114.2 days [70.1-158.3] vs. 175.7 days [153.0-198.4]; p< 0.05). Rates of mortality, pulmonary vasodilator use at discharge, tracheostomy during hospital stay, and post-operative mechanical ventilation were lower in the EL group but were not statistically significant. Supplemental oxygen need at discharge did not differ significantly between groups.
Conclusion(s): Early SL of HS PDA in ELBW neonates may improve hospital morbidity, including more favorable ventilatory outcomes and shorter hospital LOS. Prospective randomized trials are needed to address optimal timing of PDA SL.
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