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Kılıç Y, Irdem AK, Doyurgan O, Özlem G, Balik H, Bıcak EA, Salik F, Aldudak B. Ligation of patent ductus arteriosus through left anterior mini-thoracotomy in preterm infants. Cardiol Young 2022; 33:1-6. [PMID: 35611831 DOI: 10.1017/s1047951122001603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patent ductus arteriosus is an important cause of morbidity and mortality, especially in very low birth weight infants. The aim of the study is to report our single-centre short-term results of preterm patients who underwent ligation through left anterior mini-thoracotomy . METHODS Data of 27 preterm infants operated by the same surgeon who underwent Patent ductus arteriosus (PDA) closure with left anterior mini-thoracotomy technique between November 2020 and January 2022 at a single institution were reviewed. The patients were divided into two groups according to their weight at the time of surgery. Data on early postoperative outcomes and survival rates after discharge were collected. RESULTS Twenty-seven patients with a mean (±SD) gestational age of 25.8 (±2.0) weeks and a mean birth weight of 1027 (±423) g were operated using left anterior mini-thoracotomy technique. The lowest body weight was 480 g. Complications such as bleeding, abnormal healing of incision, or pneumothorax were not seen. There were 8 mortalities after the operation (29,6 %). The causes of the deaths were sepsis, necrotising enterocolitis, hydrops fetalis, hepatoblastoma, and intracranial bleeding. There was no statistically significant difference in the rates of complication between the groups. CONCLUSIONS Left anterior mini-thoracotomy technique can be performed as the first choice when transcatheter intervention cannot be applied in preterm infants. It provides easy access to the PDA, a good exposure, minimal contact with the lungs, good cosmetic results in early and mid-term and shortens the operation time, especially in very low birth weight preterm babies. However, early ligation may be helpful to minimise the complications related to PDA.
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Affiliation(s)
- Yiğit Kılıç
- Department of Pediatric Cardiac Surgery, Dr. Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Ahmet Kuddusi Irdem
- Department of Pediatric Cardiac Surgery, Dr. Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Onur Doyurgan
- Department of Pediatric Cardiac Surgery, Dr. Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Gül Özlem
- Department of Pediatric Cardiology, Dr. Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Hasan Balik
- Department of Pediatric Cardiology, Dr. Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Esra Aktiz Bıcak
- Department of Anesthesiology and Reanimation, Dr. Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Fikret Salik
- Department of Anesthesiology and Reanimation, Dicle University Medical Faculty, Diyarbakir, Turkey
| | - Bedri Aldudak
- Department of Pediatric Cardiology, Dr. Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
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Foster M, Mallett LH, Govande V, Vora N, Castro A, Raju M, Cantey JB. Short-Term Complications Associated with Surgical Ligation of Patent Ductus Arteriosus in ELBW Infants: A 25-Year Cohort Study. Am J Perinatol 2021; 38:477-481. [PMID: 31683323 DOI: 10.1055/s-0039-1698459] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This article aims to determine the incidence of short-term complications of surgical patent ductus arteriosus (PDA) ligations, the factors associated with those complications, and whether complications are associated with poor long-term outcomes. STUDY DESIGN Retrospective cohort study of all extremely low birth weight (ELBW, < 1,000 g) infants who underwent surgical PDA ligation at a single-center neonatal intensive care unit from 1989 to 2015. Demographic, clinical, and laboratory data were reviewed. The primary outcome was development of a short-term (< 2 weeks from ligation) surgical complication. Secondary outcomes include bronchopulmonary dysplasia (BPD), length of stay, and mortality. RESULTS A total of 180 ELBW infants were included; median gestational age and birth weight was 24 weeks and 683 g, respectively, and 44% of infants had at least one short-term complication. Need for vasopressors (33%) was the most common medical complication and vocal cord paralysis (9%) was the most common surgical complication. Younger corrected gestational age at time of repair was associated with increased risk for complications. Mortality, length of stay, and BPD rates were similar between infants with and without complications. CONCLUSION Serious complications were seen in a minority of infants. Additional research is needed to determine if short-term complications are associated with long-term adverse outcomes.
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Affiliation(s)
- Megan Foster
- Department of Pediatrics, Baylor Scott & White McLane Children's Medical Center, Temple, Texas
| | - Lea H Mallett
- Department of Pediatrics, Baylor Scott & White McLane Children's Medical Center, Temple, Texas
| | - Vinayak Govande
- Department of Pediatrics, Baylor Scott & White McLane Children's Medical Center, Temple, Texas
| | - Niraj Vora
- Department of Pediatrics, Baylor Scott & White McLane Children's Medical Center, Temple, Texas
| | - Abel Castro
- Department of Pediatrics, Baylor Scott & White McLane Children's Medical Center, Temple, Texas
| | - Muppala Raju
- Department of Pediatrics, Baylor Scott & White McLane Children's Medical Center, Temple, Texas
| | - Joseph B Cantey
- Department of Pediatrics, Baylor Scott & White McLane Children's Medical Center, Temple, Texas
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Akyuz M, Isik O, Mercan I, Cakmak M. Bedside surgical ligation of the patent ductus arteriosus in very-low-birth-weight premature infants: Limited upper ministernotomy as an alternative approach. J Card Surg 2020; 36:436-441. [PMID: 33283315 DOI: 10.1111/jocs.15171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patent ductus arteriosus (PDA) is an important cause of morbidity and mortality, especially in very-low-birth-weight infants. The aim of the present study was to evaluate the outcomes of bedside surgical ligation of PDA via limited upper ministernotomy as an alternative approach to thoracotomy. MATERIALS AND METHODS A total of 23 low-birth-weight premature infants, who underwent bedside ligation of PDA in the neonatal intensive care unit between January 2017 and April 2020, were enrolled. The patients were divided into two groups: those with thoracotomy (n = 13) and those with limited upper ministernotomy (n = 10). These patients were evaluated retrospectively in terms of clinical and preoperative, intraoperative, postoperative parameters between the groups. RESULTS Mean birth weight was 1059 ± 275 g in the thoracotomy group and 1035 ± 285 g in the ministernotomy group. There was no statistically significant difference in the age at surgery, weight at surgery, preoperative mechanical ventilation (MV) support, inotropic score onset of surgery, and total procedure time between the groups. There was a statistically significant difference in the hospital length of stay, postoperative MV time, and complications in the intensive care unit in favor of the ministernotomy group (p = .04, p = .03, p = .034, respectively). The study showed no statistically significant difference in the mortality rate between the two groups (two patients in the thoracotomy group and one patient in the ministernotomy group). CONCLUSION The limited upper ministernotomy is an anatomically and technically feasible alternative to classical left posterolateral thoracotomy for bedside surgical PDA ligation.
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Affiliation(s)
- Muhammet Akyuz
- Department of Congenital Heart Surgery, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Onur Isik
- Department of Congenital Heart Surgery, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ilker Mercan
- Department of Congenital Heart Surgery, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Meltem Cakmak
- Department of Anesthesiology and Reanimation, Tepecik Training and Research Hospital, Izmir, Turkey
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Pelizzo G, Bagolan P, Morini F, Aceti M, Alberti D, Andermarcher M, Avolio L, Bartoli F, Briganti V, Cacciaguerra S, Camoglio FS, Ceccarelli P, Cheli M, Chiarenza F, Ciardini E, Cimador M, Clemente E, Cozzi DA, Dall' Oglio L, De Luca U, Del Rossi C, Esposito C, Falchetti D, Federici S, Gamba P, Gentilino V, Mattioli G, Martino A, Messina M, Noccioli B, Inserra A, Lelli Chiesa P, Leva E, Licciardi F, Midrio P, Nobili M, Papparella A, Paradies G, Piazza G, Pini Prato A, Rossi F, Riccipetitoni G, Romeo C, Salerno D, Settimi A, Schleef J, Milazzo M, Calcaterra V, Lima M. Bedside surgery in the newborn infants: survey of the Italian society of pediatric surgery. Ital J Pediatr 2020; 46:134. [PMID: 32938472 PMCID: PMC7493058 DOI: 10.1186/s13052-020-00889-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction This is the report of the first official survey from the Italian Society of Pediatric Surgery (ISPS) to appraise the distribution and organization of bedside surgery in the neonatal intensive care units (NICU) in Italy. Methods A questionnaire requesting general data, staff data and workload data of the centers was developed and sent by means of an online cloud-based software instrument to all Italian pediatric surgery Units. Results The survey was answered by 34 (65%) out of 52 centers. NICU bedside surgery is reported in 81.8% of the pediatric surgery centers. A lower prevalence of bedside surgical practice in the NICU was reported for Southern Italy and the islands than for Northern Italy and Central Italy (Southern <Northern<Central, p < 0.03). The most frequent clinical characteristics of neonates was preterm neonates with birthweight < 1200 g, with cardiorespiratory instability and/or ventilatory dependence. The most frequently selected indications to surgery were pneumothorax, pleural effusion, pericardial effusion, central venous catheter (CVC) positioning, intestinal perforation, patent ductus arteriosus ligation and congenital diaphragmatic hernia. More than 60% of respondents report no institutional recommendations and dedicated informed consent on bedside surgical procedures. The lack of dedicated areas and infrastructures is considered a relative contraindication to the performance of bedside surgery. Conclusion Bedside surgery is performed in the majority of the Italian pediatric surgery centers included in this census. The introduction of a national set of surgery guidelines would be widely welcomed.
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Affiliation(s)
- Gloria Pelizzo
- Department of Paediatric Surgery, Ospedale dei Bambini "V. Buzzi" Children's Hospital, University of Milano, Milano, Italy.
| | - Pietro Bagolan
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesco Morini
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Daniele Alberti
- Department of Pediatric Surgery, Spedali Civili and University of Brescia, Brescia, Italy
| | | | - Luigi Avolio
- Pediatric Surgery Unit, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - Fabio Bartoli
- Pediatric Surgery Unit, University of Foggia, Foggia, Italy
| | - Vito Briganti
- Department of Pediatric Surgery and Urology Unit, San Camillo Forlanini Hospital, Rome, Italy
| | | | | | | | - Maurizio Cheli
- Department of Pediatric Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fabio Chiarenza
- Department of Pediatric Surgery, San Bortolo Hospital, Vicenza, Italy
| | - Enrico Ciardini
- Pediatric Surgery Unit, Ospedale Santa Chiara, Trento, Italy
| | - Marcello Cimador
- Pediatric Urology Unit, Department PRO.MI.SE, University of Palermo, Palermo, Italy
| | - Ennio Clemente
- Pediatric Surgery Unit, University of Salerno, Salerno, Italy
| | - Denis A Cozzi
- Department of Pediatrics, Sapienza University, Rome, Italy
| | - Luigi Dall' Oglio
- Digestive Endoscopy and Surgery Unit, Bambino Gesu Children's Hospital-IRCCS, Rome, Italy
| | - Ugo De Luca
- Day Surgery Unit, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Carmine Del Rossi
- Pediatric Surgery Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Ciro Esposito
- Pediatric Surgery Unit, Federico II Hospital, University of Naples, Naples, Italy
| | - Diego Falchetti
- Pediatric Surgery Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | | | | | - Valerio Gentilino
- Unit of Pediatric Surgery, Woman and Child Department, Filippo Del Ponte Hospital - ASST Sette Laghi, Varese, Italy
| | - Girolamo Mattioli
- Department of Pediatric Surgery, G. Gaslini Children's Hospital, University of Genoa, Genoa, Italy
| | - Ascanio Martino
- Pediatric Surgery Unit, Salesi Children's Hospital, Politecnico delle Marche University, Ancona, Italy
| | - Mario Messina
- Division of Pediatric Surgery, Department of Medical Sciences, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Bruno Noccioli
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
| | - Alessandro Inserra
- Surgical Oncology Unit, Department of Surgery, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Ernesto Leva
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | - Paola Midrio
- Pediatric Surgery, Ca' Foncello Hospital, Treviso, Italy
| | - Maria Nobili
- Pediatric Surgery Unit, University of Foggia, Foggia, Italy
| | - Alfonso Papparella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Giuseppe Piazza
- Pediatric Surgery Unit, Sant'Antonio Abate Hospital, Trapani, Italy
| | - Alessio Pini Prato
- Unit of Pediatric Surgery, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Fabio Rossi
- Pediatric Surgery Unit, Azienda Ospedaliero-Universitaria Maggiore della Carità , Novara, Italy
| | - Giovanna Riccipetitoni
- Pediatric Surgery Unit, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - Carmelo Romeo
- Department of Human Pathology of Adult and Childhood "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Messina, Italy
| | - Domenico Salerno
- Pediatric Surgery Unit, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | - Alessandro Settimi
- Pediatric Surgery Unit, Federico II Hospital, University of Naples , Naples, Italy
| | - Jurgen Schleef
- Department of Pediatric Surgery, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Mario Milazzo
- Pediatric Surgery Unit, Ospedale del Bambini "G. Di Cristina", ARNAS Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia and Pediatric Unit V. Buzzi Children's Hospital, Milan, Italy
| | - Mario Lima
- Department of Pediatric Surgery, University of Bologna, Bologna, Italy
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Medikal Tedaviye Yanıtsız Duktus Arteriosuslu Preterm İnfantların Tedavisinde Güvenli Bir Yöntem: Yatakbaşı Cerrahi ligasyon. JOURNAL OF CONTEMPORARY MEDICINE 2019. [DOI: 10.16899/jcm.568276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lehenbauer DG, Fraser CD, Crawford TC, Hibino N, Aucott S, Grimm JC, Patel N, Magruder JT, Cameron DE, Vricella L. Surgical Closure of Patent Ductus Arteriosus in Premature Neonates Weighing Less Than 1,000 grams: Contemporary Outcomes. World J Pediatr Congenit Heart Surg 2018; 9:419-423. [DOI: 10.1177/2150135118766454] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The safety of surgical closure of patent ductus arteriosus (PDA) in very low birth weight premature neonates has been questioned because of associated morbidities. However, these studies are vulnerable to significant bias as surgical ligation has historically been utilized as “rescue” therapy. The objective of this study was to review our institutions’ outcomes of surgical PDA ligation. Methods: All neonates with operative weight of ≤1.00 kg undergoing surgical PDA ligation from 2003 to 2015 were analyzed. Records were queried to identify surgical complications, perioperative morbidity, and mortality. Outcomes included pre- and postoperative ventilator requirements, pre- and postoperative inotropic support, acute kidney injury, surgical complications, and 30-day mortality. Results: One hundred sixty-six preterm neonates underwent surgical ligation. One hundred twenty-one (70.3%) had failed indomethacin closure. One hundred sixty-four (98.8%) patients required mechanical ventilation prior to surgery. At 17 postoperative days, freedom from the ventilator reached 50%. Of 109 (66.4%) patients requiring prolonged preoperative inotropic support, 59 (54.1%) were liberated from inotropes by postoperative day 1. Surgical morbidity was encountered in four neonates (2.4%): two (1.2%) patients had a postoperative pneumothorax requiring tube thoracostomy, one (0.6%) patient had a recurrent laryngeal nerve injury, and one (0.6%) patient had significant intraoperative bleeding. The 30-day all-cause mortality was 1.8% (n = 3); no deaths occurred intraoperatively. Conclusion: In this retrospective investigation, surgical PDA closure was associated with low 30-day mortality and minimal morbidity and resulted in rapid discontinuation of inotropic support and weaning from mechanical ventilation. Given the safety of this intervention, surgical PDA ligation merits consideration in the management strategy of the preterm neonate with a PDA.
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Affiliation(s)
| | - Charles D. Fraser
- Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Todd C. Crawford
- Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Naru Hibino
- Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Susan Aucott
- Division of Neonatology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Joshua C. Grimm
- Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nishant Patel
- Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - J. Trent Magruder
- Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Duke E. Cameron
- Division of Cardiac Surgery, The Massachusetts General Hospital, Boston, MA, USA
| | - Luca Vricella
- Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
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Kopeć-Godlewska K, Wójkowska-Mach J. Infections following surgical patent ductus arteriosus ligation in very-low-birthweight neonates. J Hosp Infect 2017; 99:62-67. [PMID: 28757329 DOI: 10.1016/j.jhin.2017.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Very-low-birthweight (VLBW) neonates (<1500g) comprise approximately 1% of liveborn infants in Poland. Patent ductus arteriosus (PDA) is a common complication of prematurity. This study aimed to determine how many VLBW neonates treated in the participating units needed surgical correction of PDA, and to evaluate the incidence of various types of postoperative infections and their microbiology. METHODS Observational study in five neonatology departments by the Polish Neonatology Surveillance Network, involving 2039 VLBW newborns of whom 103 (5.1%) required surgical PDA ligation. Continuous infection surveillance was conducted between 2009 and 2013; infections were defined based on Gastmeier's criteria. RESULTS PDA surgery was required significantly more frequently in infants from multiple pregnancies, and where labour was complicated by amnionitis. Surgical PDA correction was performed, on average, at 19 days of life. The incidence of infection was 48.5% (N = 50), and the most common infections were bloodstream infection (26.2%) and pneumonia (22.3%). A correlation was observed between the day on which the procedure was performed and the time of infection: the earlier the neonate underwent PDA surgery, the earlier the infection manifested (P = 0.032). A high CRIB score and chorioamnionitis contributed significantly to the presence of infection. CONCLUSION The later the PDA surgery was performed, the later the infection occurred. The incidence of infection after correction of PDA among VLBW neonates was comparable with the incidence of infection among all hospitalized VLBW neonates.
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Affiliation(s)
- K Kopeć-Godlewska
- Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - J Wójkowska-Mach
- Microbiology Department, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.
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Jimenez-Aceituna A, Arribas-Leal JM, Perez-Andreu J, Canovas-Lopez SJ. Escala de riesgo Aristóteles como factor predictor de mortalidad en el cierre quirúrgico de persistencia de ductus arterioso en prematuros. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2016.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Avsar MK, Demir T, Celiksular C, Zeybek C. Bedside PDA ligation in premature infants less than 28 weeks and 1000 grams. J Cardiothorac Surg 2016; 11:146. [PMID: 27716331 PMCID: PMC5050727 DOI: 10.1186/s13019-016-0539-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 09/29/2016] [Indexed: 12/03/2022] Open
Abstract
Background PDA(Patent ductus arteriosus) is a common and clinically important condition which is presented with a number of hemodynamic and respiratory problems such as intraventricular hemorrhage, pulmonary hemorrhage and necrotizing enterocolitis due to increased pulmonary blood flow and stealing from systemic circulation. The incidence of PDA among the infants that were born before the 28th gestational week is as high as 70 %; and spontaneous closure rates in very-low-birth-weight premature neonates(VLBWPN) is around 34 %. The onset, duration, and repeat number of consecutive courses of the prostaglandin synthesis inhibitor medication for PDA closure are still issues of debate. Bed-side PDA closure is a safe surgical procedure in both mature and premature babies. Here we aim to retrospectively present our 26 cases which were less than 28 weeks and 1000 grams that underwent bed-side PDA ligation. Methods This retrospective study included 26 VLBWPN with PDA that underwent bed-side ligation between 2012 and 2015. Babies were born before the 28th gestational week (23–27 weeks) and less than 1000 grams (489–970 gr). Of the 26, 15 were female and 11 were male. Indomethacin was administered to all of the cases as the medical closing agent. The medication was stopped due to unwanted effects in 6 cases. All of the patients took medical treatment before surgery. Results No surgical mortality occurred during our study. One case of pneumothorax was recorded as late surgical complication. Five of the 26 patients were lost, and the most common cause of mortality was sepsis (in 3 cases). The remaining 21 cases were discharged on days 86–238. The follow-up periods of the patients were 2 moths - 3 years. The most frequent problems encountered after discharge was chronic lung problems. Conclusions Bed side PDA ligation surgery in the ICU is a safe method for VLBWPN with clinically significant PDA.
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Affiliation(s)
- Mustafa Kemal Avsar
- Medicana International Istanbul Hospital Department of Cardiovascular Surgery, Istanbul, Turkey.
| | - Tolga Demir
- Kolan International Hospital Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Cem Celiksular
- Medicana International Istanbul Hospital Depratment of Anesthesiology, Istanbul, Turkey
| | - Cenap Zeybek
- Medicana International Istanbul Hospital Department of Pediatric Cardiology, Istanbul, Turkey
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Wang YL, Jeng SF, Tsao PN, Chou HC, Chen CY, Hsieh WS. Operating Room Within the Neonatal Intensive Care Unit--Experience of a Medical Center in Taiwan. Pediatr Neonatol 2015; 56:220-5. [PMID: 25500106 DOI: 10.1016/j.pedneo.2014.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/17/2014] [Accepted: 10/08/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Most neonates who reside in the neonatal intensive care unit (NICU) and require surgery are transferred to the operating room (OR) or undergo bedside surgery. However, critically ill neonates who are transferred often encounter the risk of complications. An OR in our NICU was therefore launched in 2009. This study was to appraise the surgeries performed in the NICU OR and compare results with the traditional main OR outside the NICU. METHODS This was a retrospective study in the NICU of a tertiary center. Retrospective chart review was conducted for all neonates who underwent surgical procedures in the NICU OR and the main OR. The information regarding baseline characteristics, surgical procedures and duration, ventilator use, hypothermia, hyperglycemia, instrument dislocations, surgically related infection or complications, and outcomes was obtained. RESULTS There were a total of 65 patients in this study, 37 in the NCIU OR group and 28 in the main OR group. The presurgical mean airway pressure and the fraction of inspired oxygen (FiO2) were comparable between the two groups, but the postsurgical FiO2 was significantly lower in the NICU OR group (31.0%) than in the main OR group (40.9%; p = 0.027). Furthermore, the NICU OR group required a significantly shorter preoperation waiting time (34.4 minutes vs. 63.6 minutes, p = 0.001) and had a lower incidence of hypothermia than the main OR group (8.1% vs. 39.3%, p = 0.008). However, surgically related complications were similar between groups. CONCLUSION The OR within the NICU may reduce the risk of complications during transportation and provide continuity of care to critically ill neonates. It also decreases the disturbance to other NICU patients during operation.
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Affiliation(s)
- Ya-Lei Wang
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Suh-Fang Jeng
- School and Graduate Institute of Physical Therapy, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Nien Tsao
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hung-Chieh Chou
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Yi Chen
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wu-Shiun Hsieh
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Abstract
BACKGROUND AND OBJECTIVE Patent ductus arteriosus (PDA) ligation has been variably associated with neonatal morbidities and neurodevelopmental impairment (NDI). The objective was to systematically review and meta-analyze the impact of PDA ligation in preterm infants at <32 weeks' gestation on the risk of mortality, severe neonatal morbidities, and NDI in early childhood. METHODS Medline, Embase, Cochrane Central Register of Controlled Trials, Education Resources Information Centre (ERIC), Cumulative Index to Nursing and Allied Health (CINAHL), PsycINFO, and the Dissertation database were searched (1947 through August 2013). Risk of bias was assessed by using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool. Meta-analyses were performed by using a random-effects model. Unadjusted and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were pooled when appropriate. RESULTS Thirty-nine cohort studies and 1 randomized controlled trial were included. Nearly all cohort studies had at least moderate risk of bias mainly due to failure to adjust for survival bias and important postnatal preligation confounders such as ventilator dependence, intraventricular hemorrhage, and sepsis. Compared with medical treatment, surgical ligation was associated with increases in NDI (aOR: 1.54; 95% CI: 1.01-2.33), chronic lung disease (aOR: 2.51; 95% CI: 1.98-3.18), and severe retinopathy of prematurity (aOR: 2.23; 95% CI: 1.62-3.08) but with a reduction in mortality (aOR: 0.54; 95% CI: 0.38-0.77). There was no difference in the composite outcome of death or NDI in early childhood (aOR: 0.95; 95% CI: 0.58-1.57). CONCLUSIONS Surgical ligation of PDA is associated with reduced mortality, but surviving infants are at increased risk of NDI. However, there is a lack of studies addressing survival bias and confounding by indication.
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Affiliation(s)
- Dany E Weisz
- Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Center, Toronto, Canada
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Outcomes following neonatal patent ductus arteriosus ligation done by pediatric surgeons: a retrospective cohort analysis. J Pediatr Surg 2013; 48:915-8. [PMID: 23701759 DOI: 10.1016/j.jpedsurg.2013.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 02/03/2013] [Indexed: 11/22/2022]
Abstract
PURPOSE Patent Ductus Arteriosus (PDA) ligation in premature infants is an urgent procedure performed by some but not all pediatric surgeons. Proficiency in PDA ligation is not a requirement of Canadian pediatric surgery training. Our purpose was to determine the outcomes of neonatal PDA ligation done by pediatric surgeons. METHODS We performed a retrospective review of premature infants who underwent PDA ligation by pediatric surgeons in 3 Canadian centers from 2005 to 2009. Outcomes were compared to published controls. RESULTS The review identified 98 patients with a mean corrected GA and weight at repair of 29 weeks and 1122 g, respectively. There were no intraoperative deaths. The 30-day and inhospital mortality rates were 1% and 5%. Mortality and morbidity were comparable to the published outcomes. CONCLUSIONS This study documents that a significant number of preterm infant PDA ligations are safely done by pediatric surgeons. To meet the Canadian needs for this service by pediatric surgeons, proficiency in PDA ligation should be considered important in pediatric surgery training programs.
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Wong C, Mak M, Shivananda S, Yang J, Shah PS, Seidlitz W, Pemberton J, Fitzgerald PG, Cameron BH. Outcomes of neonatal patent ductus arteriosus ligation in Canadian neonatal units with and without pediatric cardiac surgery programs. J Pediatr Surg 2013; 48:909-14. [PMID: 23701758 DOI: 10.1016/j.jpedsurg.2013.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 02/03/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND/PURPOSE Preterm infants needing patent ductus arteriosus (PDA) ligation are transferred to a pediatric cardiac center (CC) unless the operation can be done locally by a pediatric surgeon at a non-cardiac center (NCC). We compared infant outcomes after PDA ligation at CC and NCC. METHODS We analyzed 990 preterm infants who had PDA ligation between 2005 and 2009 using the Canadian Neonatal Network database. In-hospital mortality and major morbidities were compared between CC (n=18) and NCC (n=9). RESULTS SNAP-II-adjusted mortality rates were similar (CC=8.7% vs NCC=10.7%, P=.32). Significant cranial ultrasound abnormalities (CC=24.1% vs NCC=32.1%, P<.01) and culture-proven sepsis (CC=39.7% vs NCC=54.8%, P<.01) were more frequent in infants treated at NCC. Infants transferred to CC had higher rates of cranial ultrasound abnormalities (transferred 31.6% vs non-transferred 20.4%, P<.01). NSAIDs prior to PDA ligation were used more often at NCC (CC 36.6% vs NCC 75.6%, P<.001). CONCLUSIONS Mortality rates after PDA ligation were similar at CC and NCC, but cranial ultrasound abnormalities and sepsis rates were higher at NCC. Higher morbidity may be associated with different PDA management strategies, including NSAID use or infant transfer. Further studies are needed to investigate the reasons for these differences in morbidity.
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Affiliation(s)
- Charles Wong
- McMaster Pediatric Surgery Research Collaborative, Hamilton ON, Canada
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