Kourelis Georgios, Kanakis Meletios, Loukas Constantinos, Kakava Felicia, Kyriakoulis Konstantinos, Bobos Dimitrios, Apostolopoulou Sotiria, Rammos Spyridon, Giannopoulos Nikolaos
Pediatric Cardiac and Adult Congenital Heart Disease Intensive Care Unit, Onassis Cardiac Surgery Center, Kallithea, Greece.
Paediatric Cardiac and Adult Congenital Heart Disease Surgical Department, Onassis Cardiac Surgery Center, Kallithea, Greece.
J Pediatr Intensive Care. 2021 Jul 7;12(4):264-270. doi: 10.1055/s-0041-1731786. eCollection 2023 Dec.
Patent ductus arteriosus (PDA) has been associated with increased morbidity and mortality in preterm infants. Surgical ligation (SL) is generally performed in symptomatic infants when medical management is contraindicated or has failed. We retrospectively reviewed our institution's experience in surgical management of PDA for extremely low birth weight (ELBW) infants without chest tube placement assessing its efficiency and safety. We evaluated 17 consecutive ELBW infants undergoing SL for symptomatic PDA (January 2012-January 2018) with subsequent follow-up for 6 months postdischarge. Patients consisted of 9 (53%) females and 8 (47%) males. Mean gestational age (GA) at birth was 27.9 ± 2.1 weeks. Median values for surgical age (SA) from birth to operation was 10 days (interquartile range [IQR]: 8-12); PDA diameter 3.4 mm (IQR: 3.2-3.5); surgical weight (SW) 750 g (IQR: 680-850); and days of mechanical ventilation (DMV) as estimated by Kaplan-Meier curve 22 days (95% confidence interval: 14.2-29.8). We observed a statistically significant negative association between DMV and GA at birth (rho = - 0.587, = 0.017), SA (rho = - 0.629, = 0.009) and SW (rho = - 0.737, = 0.001). One patient experienced left laryngeal nerve palsy confirmed by laryngoscopy. Otherwise, there were no adverse events to include surgical-related mortality, recurrence of PDA, or need for chest tube placement during follow-up. SL of PDA in ELBW infants without chest tube placement is both efficient and safe. Universal consensus recommendations for the management of PDA in ELBW neonates are needed. Further study is required regarding the use of the less invasive option of percutaneous PDA closure in ELBW infants.
动脉导管未闭（PDA）与早产儿发病率和死亡率增加有关。当药物治疗禁忌或失败时，有症状的婴儿通常会进行手术结扎（SL）。我们回顾性分析了本机构对极低出生体重（ELBW）婴儿进行PDA手术治疗且未放置胸管的经验，评估其有效性和安全性。我们评估了17例因有症状PDA接受SL的连续ELBW婴儿（2012年1月至2018年1月），并在出院后进行了6个月的随访。患者包括9名（53%）女性和8名（47%）男性。出生时的平均胎龄（GA）为27.9±2.1周。从出生到手术的手术年龄（SA）中位数为10天（四分位间距[IQR]：8 - 12）；PDA直径3.4毫米（IQR：3.2 - 3.5）；手术体重（SW）750克（IQR：680 - 850）；根据Kaplan-Meier曲线估计的机械通气天数（DMV）为22天（95%置信区间：14.2 - 29.8）。我们观察到DMV与出生时的GA（rho = - 0.587，P = 0.017）、SA（rho = - 0.629，P = 0.009）和SW（rho = - 0.737，P = 0.001）之间存在统计学上显著的负相关。1例患者经喉镜检查证实有左侧喉返神经麻痹。除此之外，在随访期间没有包括手术相关死亡、PDA复发或需要放置胸管等不良事件。未放置胸管的ELBW婴儿进行PDA的SL既有效又安全。需要针对ELBW新生儿PDA管理达成普遍共识建议。对于在ELBW婴儿中使用侵入性较小的经皮PDA闭合术选项，还需要进一步研究。
