Cirugía abdominal en prematuros con persistencia de ductus arterioso / Abdominal surgery in premature infants with patent ductus arteriosus

Introducción: La persistencia de ductus arterioso (PDA), se considera un factor de riesgo para enterocolitis necrosante (ECN) y otras complicaciones digestivas en prematuros. El objetivo del presente trabajo es analizar si existe un mayor riesgo de cirugía abdominal y morbimortalidad asociada en prematuros que precisaron tratamiento debido a una PDA significativa. Metodología: Estudio observacional, analítico y retrospectivo incluyendo prematuros menores de 37 semanas de gestación, con diagnóstico de PDA en los últimos 10 años. En función del tratamiento recibido, los pacientes fueron divididos en 3 grupos: tratamiento médico (A), tratamiento médico y quirúrgico (B) y sin tratamiento (C). Se analizaron variables pre y perinatales, incidencia de complicaciones digestivas (ECN y necesidad de cirugía por este motivo) y mortalidad global. Resultados: Se obtuvo una muestra de 144 pacientes: 91 se asignaron al grupo A, 16 al B y 37 al C. La edad gestacional media por grupos fue de 28, 26,7 y 30,1 semanas. El peso medio al nacer fue de 1.083,9, 909,3 y 1471,2g, respectivamente. En cuanto a la incidencia de ECN, se encontraron un total de 21, 5 y 5 casos en cada grupo, precisando cirugía abdominal un 43, 60 y 35%, respectivamente. La mortalidad por grupos fue del 12, 19 y 3%. Conclusiones: Los pacientes que precisaron tratamiento por PDA, presentaron una mayor incidencia de complicaciones digestivas y una mayor mortalidad que los pacientes no tratados, sin embargo, no encontramos diferencias estadísticamente significativas. En el grupo de pacientes que requirieron tratamiento, la menor edad gestacional y peso al nacer, podrían explicar el incremento de la morbimortalidad encontrada en estos pacientes

Introduction: Patent ductus arteriosus (PDA) is considered a risk factor for necrotising enterocolitis (NEC) and other gastrointestinal complications in preterm infants. The aim of this study is to determine whether there is a higher incidence of abdominal surgery and the associated morbidity and mortality in preterm infants who require treatment due to a significant PDA. Methods: An observational study was conducted that included preterm infants with <37 weeks of gestational age, and a diagnosis of PDA in the last 10 years. Depending on the treatment received, the patients were divided into 3 groups: medical (A), medical and surgical (B), and no treatment (C). An analysis was performed on the pre- and peri-natal variables, as well as the incidence of gastrointestinal complications (NEC, and need for surgery for this reason), and overall mortality. Results: The study included a sample of 144 patients, of whom 91 were assigned to group A, 16 to B, and 37 to C. The mean gestational age by groups was 28, 26.7, and 30.1 weeks, respectively. The mean birth weight was 1083.9 gr, 909.3 gr, and 1471.2 gr, respectively. As regards the incidence of NEC, a total of 21, 5, and 5 cases, respectively, were found in each group, with 43%, 60% and 35%, respectively requiring abdominal surgery. Mortality by groups was 12%, 19%, and 3%, respectively Conclusion: Patients who required treatment for a significant PDA had a higher incidence of gastrointestinal complications and higher mortality than untreated patients, with no statistically significant differences being found. In the group of patients that required treatment, lower gestational age and birth weight, could explain the increase in morbidity and mortality found in these patients

[Abdominal surgery in premature infants with patent ductus arteriosus]. / Cirugía abdominal en prematuros con persistencia de ductus arterioso.

INTRODUCTION: Patent ductus arteriosus (PDA) is considered a risk factor for necrotising enterocolitis (NEC) and other gastrointestinal complications in preterm infants. The aim of this study is to determine whether there is a higher incidence of abdominal surgery and the associated morbidity and mortality in preterm infants who require treatment due to a significant PDA. METHODS: An observational study was conducted that included preterm infants with <37 weeks of gestational age, and a diagnosis of PDA in the last 10 years. Depending on the treatment received, the patients were divided into 3 groups: medical (A), medical and surgical (B), and no treatment (C). An analysis was performed on the pre- and peri-natal variables, as well as the incidence of gastrointestinal complications (NEC, and need for surgery for this reason), and overall mortality. RESULTS: The study included a sample of 144 patients, of whom 91 were assigned to group A, 16 to B, and 37 to C. The mean gestational age by groups was 28, 26.7, and 30.1 weeks, respectively. The mean birth weight was 1083.9 gr, 909.3 gr, and 1471.2 gr, respectively. As regards the incidence of NEC, a total of 21, 5, and 5 cases, respectively, were found in each group, with 43%, 60% and 35%, respectively requiring abdominal surgery. Mortality by groups was 12%, 19%, and 3%, respectively CONCLUSION: Patients who required treatment for a significant PDA had a higher incidence of gastrointestinal complications and higher mortality than untreated patients, with no statistically significant differences being found. In the group of patients that required treatment, lower gestational age and birth weight, could explain the increase in morbidity and mortality found in these patients.