Optimal timing for surgical ligation of patent ductus arteriosus in preterm infants / 中华实用儿科临床杂志

ABSTRACT

Objective To define the variables associated with preterm infants with patent ductus arteriosus (PDA) and identify the optimal timing for PDA closure clinically.Methods Three hundred and fifty-three premature babies with gestational age ＜ 32 weeks in Ba Yi Children's Hospital,Beijing Military General Hospital,from February 2011 to January 2013 were selected.Among them the PDA patients with degree of cardiovascular dysfunction using a scoring system (CVD) ≥3 scores at 48 hour life by using the cardiovascular dysfunction scoring systerm received primary drug treatment with 1-3 cycles Ibuprofen.If drug treatment failed or contraindicated,underwent surgical closure.Gestational age,body weight,presence of symptomatic hypotension,drug treatment or surgical closure were analyzed to see whether these factors were related to clinical outcomes,including hospital mortality,necrotizing enterocolitis (NEC),intraventricular hemorrhage(IVH),retinopathy(ROP) and bronchopulmonary dysplasia(BPD) at 36 weeks.Data were analyzed with Kruskal-Walls test,Wilcoxon signed rank test,Pearson x2 test,Fisher's exact test,Friedman,Halton,Logistic regression model.Results In the PDA patients with CVD≥3 scores persistently,the effectiveness of Ibuprofen was lower as time went on,PDA and BPD(OR =3.163,P =0.002),ROP(OR =2.557,P =0.007) were related markedly,and surgical treatment was possibly required.When CVD scores ≥ 3 after birth,drug treatment for one cycle was effective in 169 cases(47.8％),52 cases (14.7％) for two cycles,and 44 cases(12.5％) required surgical ligation after drug treatment failed.Such patients had younger gestational age [(29.4 ± 2.4) weeks vs (30.7 ± 1.4) weeks,P ＜ 0.000 1],and lower body weight at birth [(1 450 ± 577) g vs (1 750 ± 508) g,P =0.004).Conclusions The prolonged patency of the ductus arteriosus in preterm infants is related to an increase for IVH,BPD and ROP.Surgical ligation of PDA is a safe and effective treatment and should be done soon after two complete cycles of Ibuprofen,especially in selected patients who CVD ≥3 scores,to reduce the possibility of BPD and ROP occurence.