Predictors And Outcomes Of Open Ductus Arteriosus And Surgical Closure In Preterm Infants

Objective: To understand the clinical characteristics of patent ductus arteriosus PDA in premature infants,and to explore the predictors and outcomes of surgical closure of PDA.Methods: A retrospective analysis was performed on the premature infants who were admitted to the second department of newborn in shengjing hospital affiliated to China medical university on January 1,2013 and diagnosed by clinical combination of echocardiography with PDA on December 31,2019.The premature infants were divided into the surgical group and the non-surgical group according to whether they underwent surgical closure.The clinical data of preterm infants in the two groups were compared to understand the PDA outcome of surgical ligation and to explore its predictive factors.Results: There were 98 cases in all,including 50 males(51%)and 48 females(49%).The gestational age was 25-35 weeks,with an average gestational age of 30 weeks.Birth weight: 651-1980 g,average birth weight: 1351 g.There were 28 cases(29%)in the surgery group and 70 cases(71%)in the non-surgery group.The mean gestational age(29.3±2.4w vs 30.3±2.0w)and birth weight(1155±315gvs1430±318g)of the surgery group were significantly lower than those of the non-surgery group(P<0.05).In the surgery group,heart rate increased rapidly(>160bpm)(61%vs10%),mean pulse pressure difference(28.5mmhg vs 17.0mmhg),diuretics and positive inotropic drugs(54%vs7%),Catheter diameter(3.9±0.6mm vs2.9±0.9mm),catheter diameter/body weight(3.0mm/kg vs1.6mm /kg),left atrio-aortic root diameter ratio(LA/AO)(1.8vs1.3),and preoperative BNP maximum value(2845±1741pg/ml vs1748±1425)The incidence of pg/ml,BPD(71%vs41%)and ROP(36%vs6%),and the proportion of invasive ventilator(100%vs27%)were significantly higher than that of the non-operative group(P<0.05).Multivariate logistic regression analysis showed that pulse pressure difference,catheter diameter,catheter diameter/body weight,LA/AO,and heart rate increase were the predictors of surgical ligation PDA(P<0.05),among which catheter diameter/body weight(2.2mm/kg)had the strongest predictive ability(AUC,0.92).In the operation group,the postoperative withdrawal time of invasive respiratory support was(9±6)days,and no serious complications related to ligation were observed.Conclusion: The mean gestational age and birth weight of the surgery group were significantly lower than that of the non-surgery group.The preoperative heart rate ratio of >160bpm,the ratio of diuretics and positive inotropic drugs,the average pulse pressure difference and the highest value of BNP in the surgery group were significantly higher than those in the non-surgery group.The catheter diameter(catheter diameter/body weight)and LA/AO in the surgery group were significantly larger than those in the non-surgery group.Ductal diameter/body weight,ductal diameter,LA/AO and mean pulse pressure difference were the predictors of surgical closure of PDA,with the strongest predictors of ductal diameter/body weight(2.2mm/kg).The surgical closure of PDA promoted invasive mechanical ventilation for evacuation and failed to reduce the incidence of BPD and ROP.