Hemodynamic Instability after Patent Ductus Arteriosus Ligation in Very Low Birth Weight Infants

ABSTRACT

PURPOSE: Recently, after patent ductus arteriosus (PDA) ligation in preterm infants, unexplained hemodynamic instabilities are reported. To determine the incidence, risk factors and clinical manifestations of hemodynamic instability after PDA ligation in very low birth weight (VLBW) infants. METHODS: This retrospective multicenter study enrolled 18 VLBW infants who underwent PDA ligation from January 2002 to February 2008. Hemodynamic instability defined as unexplained cardiopulmonary dysfunction with increased dependency on mechanical ventilation and decreased blood pressure. RESULTS: The mean gestational age and birth weight (BW) of all infants were 27(+)6+/-1(+6) weeks and 951+/-245 g. Hemodynamic instability group (HI) included seven infants (39%) and hemodynamic stability group (HS) included 11 infants (61%). Compared to HS, HI had lower BW (1,033+/-285 g vs. 821+/-126 g, P=0.048) and weight on operation day (1,195+/-404 g vs. 893+/-151 g, P=0.042), longer hospital days (105+/-29 vs. 141+/-39, P=0.038), more severe bronchopulmonary dysplasia (BPD), (no/mild/moderate/severe, 2/5/2/2 vs. 0/1/2/4, P=0.038) and higher preoperative FiO2 (0.29+/-0.06 vs. 0.38+/-0.09, P=0.02). One case of mortality due to sepsis, which was not associated with ligation, was observed among HS. CONCLUSION: The incidence of hemodynamic instability after PDA ligation in VLBW infants was 39%. Low BW, low weight on operation day and preoperative high FiO2 might be risk factors of hemodynamic instability after PDA ligation in VLBW infants. The hemodynamic instability could increase the severity of BPD and hospital days.