Patent ductus arteriosus management in very-low-birth-weight prematurity: a place for an early operation?

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  • Additional Information
    • Source:
      Publisher: Oxford University Press Country of Publication: Germany NLM ID: 8804069 Publication Model: Print Cited Medium: Internet ISSN: 1873-734X (Electronic) Linking ISSN: 10107940 NLM ISO Abbreviation: Eur J Cardiothorac Surg Subsets: MEDLINE
    • Publication Information:
      Publication: 2012-: Oxford, England : Oxford University Press
      Original Publication: [Berlin] : Springer International ; [Secaucus, NJ, USA : Springer-Verlag New York Inc., distributor, c1987-
    • Subject Terms:
      Ductus Arteriosus, Patent*/surgery ; Infant, Very Low Birth Weight* ; Ibuprofen*/therapeutic use; Humans ; Infant, Newborn ; Retrospective Studies ; Male ; Female ; Ligation/methods ; Infant, Premature ; Gestational Age ; Propensity Score ; Cardiac Surgical Procedures/methods ; Cardiac Surgical Procedures/adverse effects ; Treatment Outcome ; Risk Factors
    • 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 1:1 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 1:1 matched analysis. Severe BPD was significantly higher in the late surgical closure group than in the early primary surgical closure group with 1:1 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.
      (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
    • Comments:
      Comment in: Eur J Cardiothorac Surg. 2024 Jun 3;65(6):ezae232. doi: 10.1093/ejcts/ezae232. (PMID: 38857447)
    • Contributed Indexing:
      Keywords: Patent ductus arteriosus; Preterm; Surgical closure; Very-low-birth-weight
    • Publication Date:
      Date Created: 20240509 Date Completed: 20240517 Latest Revision: 20240621
    • Publication Date:
      20240621
    • Accession Number:
      10.1093/ejcts/ezae175
    • Accession Number:
      38724226