Presented at the Neonatal Society 2002 Autumn Meeting.
Lee L1, Kelsall W1, Tillet A2, Yates R3, Tulloh R2
1 NICU, Rosie Maternity Hospital, Addenbrooke’s NHS Trust, Cambridge, UK
2 Paediatric Cardiology, Guys and St Thomas Hospital, London, UK
3 Department of Cardiology, Great Ormond Street Hospital, London, UK
Introduction: Poor outcomes have recently been reported for VLBW infants with congenital heart disease (1). However this data did not include outcome after isolated patent ductus arteriosus (PDA) ligation. The PDA can be a serious problem for the premature neonate. It is associated with chronic lung disease (CLD), necrotising enterocolitis (NEC), intraventricular haemorrhage (IVH) and retinopathy of prematurity (ROP). Surgical ligation may be performed for symptomatic PDAs when medical treatment fails or is contraindicated. Our aim was to determine early and late survival after PDA ligation and the incidence of associated morbidity in this high risk group.
Methods: Patients operated on between 1995 and 2000 were identified from databases at two cardiothoracic centres and one regional neonatal intensive care unit which performed neonatal PDA ligations. We excluded those with birth gestational age >35 weeks and any other congenital heart disease. Data was obtained from retrospective case notes review and correspondence with the referring hospitals.
Results: 98 infants were identified. Full follow-up data was available for 79 (81%). Cohort characteristics expressed as median (range) were: birth gestation 26 (22-35) weeks, birth weight 785 (511-2268) grams, age at ligation 27 (10-93) days, weight at ligation 998 (550-2920) grams. Survival was 97% at day 7, 92% at day 30 and 78% long term. 10 of the 16 deaths (63%) were of respiratory causes; 7 (44%) of these were due to CLD. The percentage incidence of associated morbidity in survivors was 22% for NEC, 29% for ROP, 38% for IVH, and 83% for CLD.
Conclusions: Although not a complex congenital heart condition, PDAs requiring surgical ligation are associated with a high late mortality. NEC, ROP and IVH are common associated co-morbidities, but there is a particularly high incidence of CLD in neonates requiring PDA ligation.
References
1. Kecskes A, Cartwright DW Arch Dis Child 2002;87(1):F31-F33