Surgical closure of patent ductus arteriosus in extremely low birth weight infants weighing less than 750 grams.

BACKGROUND

Patent ductus arteriosus (PDA) occurs more frequently in premature infants. Depending on the degree of prematurity, these children often have other serious comorbidities that could have a significant impact on surgical outcome.

AIM: This study aimed to evaluate the clinical results of surgical ligation of PDA in extremely low body weight preterm infants with birth weight below 750 g, and to identify risk factors of mortality.

METHODS

A total of 31 preterm infants with birth weight below 750 g and significant PDA were operated between 2006 and 2016 through posterolateral thoracotomy (n = 16) or with the use of video-assisted thoracoscopic method (n = 15). Mean weight at the time of surgery was 750.8 ± 104.7 g. The gestational age ranged from 22 to 32 weeks. Data were retrospectively analysed, and prospective 100% follow-up was performed.

RESULTS

In-hospital mortality was 25.8% (n = 8). The type of surgery had no influence on the results. During the follow-up period lasting 5.2 ± 2.5 years, two other patients died. One-year and five-year probability of survival was 77.4% and 74.2%, respectively. The predominant cause of death was acute heart failure. All patients with preoperative renal dysfunction died in the postoperative period. Moreover, Cox regression analysis revealed renal dysfunction as an independent risk factor of early death.

CONCLUSIONS

Preterm infants with birth weight less than 750 g and significant PDA are highly challenging patients. Despite the recent advances in perioperative management with neonates, surgery is still associated with a high early mortality rate irrespective of the applied method.