ABSTRACT
Patent ductus arteriosus( PDA) has high morbidity in new-borns. This disease tends to occur in premature,especially in the low-birth-weight infants. It can lead to severe complications including intracranial hemorrhage,respiratory distress syndrome,and chronic lung disease without treatment. Treatment for PDA usual-ly involves medications,operations,interventions and symptomatic treatment. This paper summarizes the progres-ses of the therapy of PDA in low-birth-weight premature infants.
ABSTRACT
BACKGROUND: Left-to-right shunt through patent ductus arteriosus (PDA) produces significant hemodynamic and respiratory derangements in premature infants. Combined diseases in these patients often preclude attempts to close the PDA medically with indomethacin. Recently, the efficacy of early surgical closure performed in neonatal intensive care unit (NICU) rather than in operating room (OR) has been emphasized to reduce the risks of transferring unstable infants. Therefore, we reviewed the anesthetic management and clinical status of premature infants who underwent early surgical closure of PDA in NICU. METHODS: Between 2001 and 2007, we reviewed retrospectively 17 premature infants with extremely low birth weight below 1,500 g and 33 weeks gestational age who underwent early ligation of PDA in NICU with left axillary minithoracotomy. RESULTS: The mean gestational age and weight of infants were 29.4 +/- 1.8 (26(+3) - 32) weeks and 849 +/- 165 (450 - 1,080) g. Most of the infants had complications related to PDA and prematurity. Diastolic blood pressure and pulse oxymetry saturation changed with ligation of PDA from 27.4 +/- 5.3 mmHg and 96.3 +/- 2.9% to 38.1 +/- 10.0 mmHg and 93.8 +/- 2.6%, respectively. The body temperature didn't show significant alterations. There was no direct procedure-related death although threeinfants died from pneumonia and sepsis at 29, 30 and 34 days postoperatively. CONCLUSIONS: Performing early PDA ligation in NICU was demonstrated to be safe and effective, especially in terms of providing continuous care and avoiding the risk of hypothermia.
Subject(s)
Humans , Infant , Infant, Newborn , Blood Pressure , Body Temperature , Ductus Arteriosus, Patent , Gestational Age , Hemodynamics , Hypothermia , Indomethacin , Infant, Low Birth Weight , Infant, Premature , Intensive Care, Neonatal , Ligation , Operating Rooms , Pneumonia , Retrospective Studies , SepsisABSTRACT
BACKGROUND: A delay in spontaneous closure of the patent ductus arteriosus (PDA) is frequent in premature infant and may lead to cardiopulmonary congestion and death. Surgical closure of the PDA in the premature infant can be a safe and effective procedure. Now, several centers prefer to eliminate the problem of transportation to operating room and adopt the policy of operating in the newborn intensive care unit (NBICU). So we investgated the anesthetic management and clinical status of premature infants who underwent surgical closure of PDA. METHODS: We analyzed retrospectively the anesthetic management and clinical status of eleven premature infants below 1,500 g birth weight. RESULTS: Range of gestational age of infants was 24-30 weeks. Most common cause of operation was failure of medical treatment. All infants had features of respiratory distresses and prematurity complications. Fentanyl, vecuronium, oxygen, and air constituted a anesthetic regimen. The body temperature remained stable. Systemic blood pressure with ligation of PDA increased to 66.3 17.4 mmHg (mean+/-SD). After operation, three infants died from complication of prematurity. There were no deaths directly related to operation. Four infants underwent operation in NBICU and also had no wound infections. CONCLUSIONS: Premature infants with PDA had associated complications of prematurity and were severely ill. If the infants did not respond to medical therapy, the PDA was closed by operation with adequate anesthesia. Furthermore, the operation can be performed safely and efficiently in the operating room or NBICU.
Subject(s)
Humans , Infant , Infant, Newborn , Anesthesia , Birth Weight , Blood Pressure , Body Temperature , Ductus Arteriosus, Patent , Estrogens, Conjugated (USP) , Fentanyl , Gestational Age , Infant, Premature , Infant, Very Low Birth Weight , Intensive Care Units , Ligation , Operating Rooms , Oxygen , Retrospective Studies , Transportation , Vecuronium Bromide , Wound InfectionABSTRACT
Objective To study the incidence of vitamin K deficiency in low-birth weight premature infants and its relationship with intraventricular hemorrhage.Methods We use emzymoimmunoelectrophoresis to detect prophrombin protein precursors(PIVKA-Ⅱ) in vein blood in premature infants