This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (3)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Gould, D. S.
Right arrow Articles by Nicolson, S. C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Gould, D. S.
Right arrow Articles by Nicolson, S. C.
Related Collections
Right arrow Premature & Newborn
PEDIATRICS Vol. 112 No. 6 December 2003, pp. 1298-1301

A Comparison of On-Site and Off-Site Patent Ductus Arteriosus Ligation in Premature Infants

Douglas S. Gould, CRNA, MS*, Lisa M. Montenegro, MD*, J. William Gaynor, MD{ddagger}, Suzanne P. Lacy, CRNA, MS*, Richard Ittenbach, PhD§, Paul Stephens, MD||, James M. Steven, MD*, Thomas L. Spray, MD{ddagger} and Susan C. Nicolson, MD*

* Divisions of Cardiothoracic Anesthesia
{ddagger} Cardiothoracic Surgery
|| Cardiology
§ Biostatistics and Epidemiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

Introduction. Persistent patent ductus arteriosus (PDA) often produces hemodynamic and respiratory derangement necessitating use of inotropic drugs and escalating ventilatory support in premature infants. When medical therapy fails, surgical ligation is indicated. Because of the risks of transferring unstable neonates to the operating room, ductal ligation is routinely performed at the neonatal intensive care unit (NICU) bedside. Some patients, however, require transfer from hospitals without pediatric cardiac surgical teams. In an attempt to eliminate the risks associated with transfer, a surgical team from our institution offered to perform duct ligation in the NICUs of referring institutions. This experienced team consisted of a pediatric cardiac attending anesthesiologist and certified registered nurse anesthetist, cardiac operating room nurses, an attending cardiothoracic surgeon, and a cardiothoracic surgery fellow. We retrospectively reviewed our experience.

Methods. After approval from the Committee for the Protection of Human Subjects, the charts of premature neonates who underwent PDA ligation in the NICU at the Children’s Hospital of Philadelphia NICU or in a network NICU between January 1996 and April 2002 were reviewed. Data abstracted included institution, gender, gestational age, birth weight, weight at surgery, and number of courses of indomethacin. Mean arterial blood pressure and use of inotropic drugs and ventilatory parameters (fraction of inspired oxygen, peak inspiratory pressure) were recorded at the time of surgery and 96 hours postoperatively. Perioperative complications were recorded.

Results. Seventy-two patients met the criteria for inclusion. PDA ligation was performed in the Children’s Hospital of Philadelphia NICU in 38 of 72 patients, 53% (group 1). The remainder, 34 of 72 (47%) underwent PDA ligation in the NICU at 1 of 6 referring institutions (group 2). There were no significant differences between groups with respect to demographics, number of courses of indomethacin, or use of inotropic drugs or ventilatory support. The incidence of perioperative complications did not differ between groups: 3 in group 1 (bleeding, chylothorax, and pleural effusion) and 3 in group 2 (pneumothorax [3]). There were no anesthetic-related complications. Seven patients died (4 in group 1 and 3 in group 2), none within 96 hours of surgery and none secondary to the procedure.

Discussion. The data demonstrate that an experienced team can perform PDA ligation safely in NICUs of hospitals without on-site pediatric cardiac surgical capabilities in critically ill neonates without incurring the risks inherent in patient transport. Most importantly, patient care is continued by the neonatology team most familiar with the infant’s medical and social history, and the patient’s family is minimally inconvenienced.

Key Words: patent ductus arteriosus (PDA) • PDA ligation • NICU • premature infant

Abbreviations: PDA, patent ductus arteriosus • NICU, neonatal intensive care unit

Received for publication Sep 26, 2002; Accepted Mar 27, 2003.




This article has been cited by other articles:


Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
B M Huning, B Asfour, S Konig, N Hess, and C Roll
Cerebral blood volume changes during closure by surgery of patent ductus arteriosus
Arch. Dis. Child. Fetal Neonatal Ed., July 1, 2008; 93(4): F261 - F264.
[Abstract] [Full Text] [PDF]