Patent ductus arteriosus management in very-low-birth-weight prematurity: a place for an early operation?
Eur J Cardiothorac Surg
; 65(5)2024 May 03.
Article
in En
| MEDLINE
| ID: mdl-38724226
ABSTRACT
OBJECTIVES:
The goal was to evaluate neonatal outcomes based on treatment strategies and time points for haemodynamically significant patent ductus arteriosus (hsPDA) in very-low-birth-weight preterm infants, with a particular focus on surgical closure.METHODS:
This retrospective study included very-low-birth-weight infants born between 2014 and 2021 who received active treatment for hsPDA. Neonatal outcomes were compared between (i) primary surgical closure versus primary ibuprofen; (ii) early (<14th post-natal day) versus late primary surgical closure (≥14th post-natal day); and (iii) primary versus secondary surgical closure after ibuprofen failure. Further analysis using 11 propensity score matching was performed. Logistic regression was conducted to analyse the risk factors for post-ligation cardiac syndrome (PLCS) and/or acute kidney injury (AKI).RESULTS:
A total of 145 infants with hsPDA underwent active treatment for closure. The in-hospital death rate and the incidence of severe bronchopulmonary dysplasia (BPD) were similar between the primary surgical closure group and the primary ibuprofen group in a 11 matched analysis. Severe BPD was significantly higher in the late surgical closure group than in the early primary surgical closure group with 11 propensity score matching (72.7% vs 40.9%, P=0.033). The secondary surgical closure group showed the mildest clinical condition; however, the probability of PLCS/AKI was highest (38.6%) compared to the early (15.2%) or the late primary surgical group (28.1%, P<0.001), especially in extremely premature infants (gestational age < 28 weeks).CONCLUSIONS:
Surgical patent ductus arteriosus closure is not inferior to pharmacologic treatment. Considering the harmful effect of a prolonged patent ductus arteriosus shunt exposure, a timely decision and timely efforts should be made to minimize the risk of severe BPD and PLCS/AKI after surgical closure.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Ibuprofen
/
Infant, Very Low Birth Weight
/
Ductus Arteriosus, Patent
Limits:
Female
/
Humans
/
Male
/
Newborn
Language:
En
Journal:
Eur J Cardiothorac Surg
Journal subject:
CARDIOLOGIA
Year:
2024
Document type:
Article
Publication country:
ALEMANHA
/
ALEMANIA
/
DE
/
DEUSTCHLAND
/
GERMANY