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Outcomes following neonatal patent ductus arteriosus ligation done by pediatric surgeons: a retrospective cohort analysis.

https://arctichealth.org/en/permalink/ahliterature113671
Source
J Pediatr Surg. 2013 May;48(5):915-8
Publication Type
Article
Date
May-2013
Author
Katherine Hutchings
Andrea Vasquez
David Price
Brian H Cameron
Saeed Awan
Grant G Miller
Author Affiliation
Department of Surgery, Janeway Children's Hospital, St. John's Newfoundland, NL, Canada, A1B 3V6.
Source
J Pediatr Surg. 2013 May;48(5):915-8
Date
May-2013
Language
English
Publication Type
Article
Keywords
Blood Transfusion - utilization
Canada - epidemiology
Comorbidity
Ductus Arteriosus, Patent - drug therapy - mortality - surgery
Female
Follow-Up Studies
General Surgery - education
Gestational Age
Hospital Mortality
Hospitals, Pediatric - organization & administration - statistics & numerical data
Hospitals, Teaching - organization & administration - statistics & numerical data
Humans
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases - mortality - surgery
Intensive Care Units, Neonatal - statistics & numerical data
Intraoperative Complications - epidemiology
Ligation - education
Male
Patient Transfer - statistics & numerical data
Pediatrics - education
Postoperative Complications - epidemiology
Respiration, Artificial - utilization
Retrospective Studies
Tertiary Care Centers - organization & administration - statistics & numerical data
Treatment Outcome
Abstract
Patent Ductus Arteriosus (PDA) ligation in premature infants is an urgent procedure performed by some but not all pediatric surgeons. Proficiency in PDA ligation is not a requirement of Canadian pediatric surgery training. Our purpose was to determine the outcomes of neonatal PDA ligation done by pediatric surgeons.
We performed a retrospective review of premature infants who underwent PDA ligation by pediatric surgeons in 3 Canadian centers from 2005 to 2009. Outcomes were compared to published controls.
The review identified 98 patients with a mean corrected GA and weight at repair of 29 weeks and 1122 g, respectively. There were no intraoperative deaths. The 30-day and inhospital mortality rates were 1% and 5%. Mortality and morbidity were comparable to the published outcomes.
This study documents that a significant number of preterm infant PDA ligations are safely done by pediatric surgeons. To meet the Canadian needs for this service by pediatric surgeons, proficiency in PDA ligation should be considered important in pediatric surgery training programs.
PubMed ID
23701759 View in PubMed
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Outcomes of neonatal patent ductus arteriosus ligation in Canadian neonatal units with and without pediatric cardiac surgery programs.

https://arctichealth.org/en/permalink/ahliterature113672
Source
J Pediatr Surg. 2013 May;48(5):909-14
Publication Type
Article
Date
May-2013
Author
Charles Wong
Michael Mak
Sandesh Shivananda
Junmin Yang
Prakeshkumar S Shah
Wendy Seidlitz
Julia Pemberton
Peter G Fitzgerald
Brian H Cameron
Author Affiliation
McMaster Pediatric Surgery Research Collaborative, Hamilton ON, Canada.
Source
J Pediatr Surg. 2013 May;48(5):909-14
Date
May-2013
Language
English
Publication Type
Article
Keywords
Abnormalities, Multiple - epidemiology
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Brain Diseases - epidemiology - etiology - ultrasonography
Canada
Cardiology Service, Hospital - organization & administration
Combined Modality Therapy
Databases, Factual
Ductus Arteriosus, Patent - drug therapy - mortality - surgery
Female
Hospital Departments - organization & administration
Hospital Mortality
Humans
Infant, Low Birth Weight
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases - mortality - surgery
Infant, Small for Gestational Age
Intensive Care Units, Neonatal - statistics & numerical data
Ligation
Male
Patient Transfer - statistics & numerical data
Pediatrics - organization & administration
Postoperative Complications - epidemiology - etiology - ultrasonography
Retrospective Studies
Sepsis - epidemiology - etiology
Severity of Illness Index
Surgery Department, Hospital - organization & administration
Tertiary Care Centers - organization & administration - statistics & numerical data
Treatment Outcome
Abstract
Preterm infants needing patent ductus arteriosus (PDA) ligation are transferred to a pediatric cardiac center (CC) unless the operation can be done locally by a pediatric surgeon at a non-cardiac center (NCC). We compared infant outcomes after PDA ligation at CC and NCC.
We analyzed 990 preterm infants who had PDA ligation between 2005 and 2009 using the Canadian Neonatal Network database. In-hospital mortality and major morbidities were compared between CC (n=18) and NCC (n=9).
SNAP-II-adjusted mortality rates were similar (CC=8.7% vs NCC=10.7%, P=.32). Significant cranial ultrasound abnormalities (CC=24.1% vs NCC=32.1%, P
PubMed ID
23701758 View in PubMed
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Timing of pharmacological treatment for patent ductus arteriosus and risk of secondary surgery, death or bronchopulmonary dysplasia: a population-based cohort study of extremely preterm infants.

https://arctichealth.org/en/permalink/ahliterature267589
Source
Neonatology. 2015;107(2):87-92
Publication Type
Article
Date
2015
Author
Anna Gudmundsdottir
Stefan Johansson
Stellan Håkansson
Mikael Norman
Karin Källen
Anna-Karin Bonamy
Source
Neonatology. 2015;107(2):87-92
Date
2015
Language
English
Publication Type
Article
Keywords
Bronchopulmonary Dysplasia - prevention & control
Cohort Studies
Cyclooxygenase Inhibitors - therapeutic use
Ductus Arteriosus, Patent - drug therapy - mortality - surgery
Female
Gestational Age
Humans
Ibuprofen - therapeutic use
Indomethacin - therapeutic use
Infant, Extremely Premature - physiology
Infant, Newborn
Logistic Models
Male
Sweden
Time-to-Treatment
Abstract
The optimal timing of pharmacological treatment for patent ductus arteriosus (PDA) in extremely preterm infants is unknown.
To investigate whether timing of pharmacological PDA treatment is associated with a risk of secondary PDA surgery or death before 3 months of age, or bronchopulmonary dysplasia (BPD) in extremely preterm infants.
In this population-based cohort of infants born before 27 gestational weeks in Sweden in 2004-2007, 290/585 infants (50%) received pharmacological PDA treatment. Cox proportional hazards regression estimated the hazard ratio (HR, with 95% confidence interval, CI) of secondary PDA surgery or death as a composite outcome in relation to postnatal age at the start of pharmacological treatment: early (0-2 days); intermediate (3-6 days); late (=7 days). Furthermore, the odds ratio (OR, with 95% CI) of BPD was estimated in relation to postnatal age at PDA treatment by conditional logistic regression.
The median postnatal age at the start of pharmacological PDA treatment was 4 days. 102 infants had secondary PDA surgery. Timing of PDA treatment was not associated with risk of PDA surgery or death; adjusted HRs were 0.89 (95% CI 0.57-1.39) after an intermediate start and 1.10 (95% CI 0.53-2.28) after a late start, compared to an early start of treatment. Compared to the early start of PDA treatment, the intermediate start was not associated with any risk of BPD, while late PDA treatment was associated with a lower BPD risk; adjusted ORs were 0.83 (95% CI 0.42-1.64) and 0.28 (95% CI 0.13-0.61), respectively.
Timing of pharmacological PDA treatment after extremely preterm birth is not associated with the risk of secondary PDA surgery or death. Moreover, expectant PDA management is not associated with an increased risk of BPD.
Notes
Comment In: Neonatology. 2015;107(4):25625721918
Comment In: Neonatology. 2015;107(4):25725720362
Comment In: Neonatology. 2015;108(2):9926068311
PubMed ID
25412681 View in PubMed
Less detail