Short-term outcome of PDA ligation in the preterm infants at King Chulalongkorn Memorial Hospital, Thailand.

BACKGROUND

Failure of the ductus arteriosus to close after medical treatment is usually associated with many severe cardio-respiratory morbidities. Therefore, surgical ligation of symptomatic PDA is indicated in preterm newborn infants who do not respond or have contraindication of medical treatment.

OBJECTIVE

To report the short-term outcomes of PDA ligation in preterm infants at a tertiary care hospital in Thailand.

MATERIAL AND METHOD

Medical records of 42 preterm infants who underwent surgical ligation of PDA at King Chulalongkorn Memorial Hospital were reviewed All of the infants had symptomatic PDA that failed to respond to medical treatment or had a contraindication to indomethacin or ibuprofen. Surgical ligation of PDA was performed under general anesthesia. Morbidity and mortality occurring during hospitalization were reported.

RESULTS

There were 42 preterm infants in the present study. All of them had large PDA with intractable congestive heart failure. Mean + SD of birth weight and gestational age were 1206 +/- 567 grams and 28.7 +/- 3.6 weeks respectively. Mean +/- SD of the infants' weight and age at the time of surgery were 1089 +/- 549 grams and 17.5 +/- 12 days respectively. Data on the size of PDA was available on 21 preterm infants. Their ductus diameter (Mean +/- SD) was 3.1 +/- 1.1 mm. All infants were successfully extubated after PDA ligation. Twelve events of complications occurred in 11 infants (26.7%). All of the complications were of mild degree and resolved within a few days except one infant with left phrenic nerve injury that needed surgical plication of the diaphragm. Two infants died at 37 and 160 days after surgery and the latter infant developed IVH grade IV on the 15th day postoperatively. These complications were probably not related to PDA ligation.

CONCLUSION

PDA ligation was performed successfully on 42 preterm infants who had medical failure or had contraindication to medical treatment. Cardio-respiratory illnesses improved significantly after ligation. Two infant mortalities were not related to the procedure. Overall complication of surgery was 26.7% and resolved without sequelae.