J Korean Med Sci.  2014 Apr;29(4):581-586. 10.3346/jkms.2014.29.4.581.

The Timing of Surgical Ligation for Patent Ductus Arteriosus Is Associated with Neonatal Morbidity in Extremely Preterm Infants Born at 23-25 Weeks of Gestation

• Sung SI
• Choi SY
• Park JH
• Lee MS
• Yoo HS
• Ahn SY
• Chang YS
• Park WS

• KMID: 1774466
• DOI: http://doi.org/10.3346/jkms.2014.29.4.581

Abstract

The purpose of this study was to evaluate prognostic factors associated with surgical ligation for patent ductus arteriosus (PDA) in extremely preterm infants born at the limits of viability. Ninety infants who were born at 23-25 weeks of gestation and who received surgical ligation were included and their cases were retrospectively reviewed. Infants were classified into two different groups: survivors with no major morbidity (N), and non-survivors or survivors with any major morbidity (M). Clinical characteristics were compared between the groups. Possible prognostic factors were derived from this comparison and further tested by logistic regression analysis. The mean gestational age and the mean birth weight of M were significantly lower than those of N. Notably, the mean postnatal age at time of ligation in N was significantly later than that of the other group (17+/-12 vs 11+/-8 days in N and M, respectively). An adjusted analysis showed that delayed ligation (>2 weeks) was uniquely associated with a significantly decreased risk for mortality or composite morbidity after surgical ligation (OR, 0.105; 95% CI, 0.012-0.928). In conclusion, delayed surgical ligation for PDA (>2 weeks) is associated with decreased mortality or morbidities in extremely preterm infants born at 23-25 weeks of gestation.

Keyword

Ductus Arteriosus, Patent; Ligation; Indomethacin; Ibuprofen

MeSH Terms

Adult
Birth Weight
Demography
Ductus Arteriosus, Patent/diagnosis/epidemiology/*surgery
Female
Gestational Age
Humans
Infant, Extremely Premature
Infant, Newborn
Logistic Models
Male
Odds Ratio
Prognosis
Retrospective Studies
Time Factors

Figure

• 

  Fig. 1 A flow diagram of the study population and management of PDA therein. EPI, extremely preterm infants born at 23-25 weeks of gestation; HSPDA, hemodynamically significant PDA.

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