Evaluation of postoperative complications for PDA in extremely low birth weight infants

Pediatr Int. 2021 Apr 30. doi: 10.1111/ped.14759. Online ahead of print.


BACKGROUND: Patent ductus arteriosus (PDA), which disrupts the hemodynamics early after birth, causes intraventricular hemorrhage and neonatal necrotizing. Unlike medical treatment for hemodynamically significant PDA, there are disparities between institutions regarding the timing of surgery, considering the complications associated with surgery or access to surgery.

METHODS: We aimed clarify the clinical picture of postoperative complications and examined whether there were risk factors regarding that indication of surgery for hemodynamically significant PDA from the point of postoperative complications associated with surgery.

RESULTS: There were 36 cases of extremely low birth weight infants who required video-assisted thoracoscopic surgery for PDA (VATS-PDA). The median gestational age was 25.2 weeks, and the median birth weight was 699 g. The treatment indication of VATS-PDA was medical treatment resistance in 17 cases, relapsed PDA in 15 cases, and no additional administration of indomethacin because of severe side effects in four cases. Complications with VATS-PDA occurred in eight out of 36 cases. There were three cases of pneumothorax, two of thoracotomy transition, two of pulmonary hemorrhage, and four of post-ligation cardiac syndrome (PLCS). VATS-PDA-related death occurred in two cases because of PLCS. The frequency of four or more times of indomethacin with or without postoperative complications was 88% vs. 39% (p=0.04), respectively.

CONCLUSIONS: All postoperative deaths were caused by PLCS, which had the highest risk of poor prognosis. VATS-PDA should be considered for unclosed PDA after one course of indomethacin administration.

PMID:33930217 | DOI:10.1111/ped.14759