Surgical management of patent ductus arteriosus in pre-term infants - a British paediatric surveillance study

Warnock, A.; Szatkowski, L.; Lakshmanan, A.; Lee, L.; Kelsall, W.

Abstract

Background: This study aimed to provide UK data describing the incidence of patent ductus arteriosus (PDA) surgery in the neonatal population, including: pre-ligation management, and outcomes until discharge. We used British Paediatric Surveillance Unit (BPSU) methodology; collecting data via questionnaires for preterm neonates undergoing PDA ligation (PDAL) between 1st Sept 2012 – 30th Sept 2013. Infants born less than 37 weeks gestation, who underwent PDAL prior to discharge home, with no other structural cardiac abnormality, were included. Information collected included: patient demographics, pre and post-operative clinical characteristics, pre-operative medical management, post-operative complications and outcome. Results: Over the study, 263 infants underwent PDAL an incidence of 3.07 per 10,000 live births. 88% were born extremely preterm (< 28 weeks) and 60% were male. The commonest reasons for ligation were inability to wean respiratory support (83.7%) and haemodynamically significant PDA (87.8%). Pre-operatively 65.7% received medical therapy. Surgery was performed at a median age of 33 days (range 9-260, IQR 24-48); the corrected age was less than 31 + 6 week in 50.6% babies at PDAL. Most, (90%), of procedures were open ligation; only 9 (3.4%) were catheter occlusions (PDACO). 20.5% of patients had post-operative complications. The 30-day mortality was 3%, with 93.5% surviving to hospital discharge. Conclusion: This study showed there was little consensus over medical and surgical management of the PDA or timing of surgery.

Citation

Warnock, A., Szatkowski, L., Lakshmanan, A., Lee, L., & Kelsall, W. (2021). Surgical management of patent ductus arteriosus in pre-term infants - a British paediatric surveillance study. BMC Pediatrics, 21, Article 270. https://doi.org/10.1186/s12887-021-02734-9

• Journal Article Type: Article
• Acceptance Date: May 21, 2021
• Online Publication Date: Jun 9, 2021
• Publication Date: Jun 9, 2021
• Deposit Date: Jun 9, 2021
• Publicly Available Date: Jun 17, 2021
• Journal: BMC Pediatrics
• Electronic ISSN: 1471-2431
• Publisher: Springer Science and Business Media LLC
• Peer Reviewed: Peer Reviewed
• Volume: 21
• Article Number: 270
• DOI: https://doi.org/10.1186/s12887-021-02734-9
• Keywords: Neonatal, Patent Ductus Arteriosus, Ligation, Preterm, Cardiothoracic
• Public URL: https://nottingham-repository.worktribe.com/output/5652152
• Publisher URL: https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-021-02734-9
• Additional Information: Received: 23 March 2021; Accepted: 21 May 2021; First Online: 9 June 2021; : ; : Application was made to BPSU in 2011 with permission to proceed in September 2012. Funding was through the Sir Peter Tizard Bursary (held by Dr. Lee). Study ethics approval was granted by NRES Committee - East Midlands - Derby (Reference: ECC 3-02(FT6)/2012.All clinical and study procedures were performed according to approved local protocol. Informed consent from study participants, their parents/guardians (written or verbal) for use of routinely collected, then anonymized data was not necessary as per BPSU agreement with the national Confidentiality Advisory Group and Health Research Authority.; : Not applicable.; : The authors declare that they have no competing interests.