Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Comparison of ‘post-patent ductus arteriosus ligation syndrome’ in premature infants after surgical ligation vs. percutaneous closure

Journal of Perinatology volume 40, pages 324–329 (2020)Cite this article

Subjects

Abstract

Objective

To compare the incidence of post-PDA ligation syndrome after surgical vs. percutaneous closure of PDAs in very low birth weight (VLBW) infants.

Study design

Cohort study comparing 59 infants who underwent surgical ligation with 25 infants who underwent percutaneous closure. Comparisons between groups were made using two-sample t-tests and a Fisher’s exact test. Comparisons of pre vs. post variables within each group were made using paired t-tests.

Results

Patients who underwent surgical ligation had a higher need for initiation of post-procedure hemodynamic support (12/59 vs. 0/24, p = 0.016), a higher post-procedure peak FiO2 (0.64 vs. 0.43, p = 0.004), and a larger absolute change in peak FiO2 (0.23 vs. 0.09, p = 0.008).

Conclusion

VLBW infants who had percutaneous closure of their PDA did not experience post ligation syndrome and had less escalation of respiratory support compared with infants who underwent surgical ligation.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Chiruvolu A, Punjwani P, Ramaciotti C. Clinical and echocardiographic diagnosis of patent ductus arteriosus in premature neonates. Early Hum Dev. 2009;85:147–9.

    Article  Google Scholar 

  2. Dollberg S, Lusky A, Reichman B. Patent ductus arteriosus, indomethacin and necrotizing enterocolitis in very low birth weight infants: a population-based study. J Pediatr Gastroenterol Nutr. 2005;40:184–8.

    Article  CAS  Google Scholar 

  3. Evans N, Kluckow M. Early ductal shunting and intraventricular haemorrhage in ventilated preterm infants. Arch Dis Child Fetal Neonatal Ed. 1996;75:F183–F186.

    Article  CAS  Google Scholar 

  4. Garland J, Buck R, Weinberg M. Pulmonary hemorrhage risk in infants with a clinically diagnosed patent ductus arteriosus: a retrospective cohort study. Pediatrics. 1994;94:719–72.

    CAS  PubMed  Google Scholar 

  5. Cunha GS, Mezzacappa-Filho F, Ribeiro JD. Risk factors for bronchopulmonary dysplasia in very low birth weight newborns treated with mechanical ventilation in the first week of life. J Trop Pediatr. 2005;51:334–40. 10.1093

    Article  Google Scholar 

  6. Benitz WE. Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis? J Perinatol. 2010;30:241–52.

    Article  CAS  Google Scholar 

  7. Benitz WE. Patent ductus arteriosus in preterm infants. Pediatrics. 2016;137:e20153730.

    Article  Google Scholar 

  8. Noori S. Pros and cons of patent ductus arteriosus ligation: hemodynamic changes and other morbidities after patent ductus arteriosus ligation. Sem Perintaol. 2012;139–45.

    Article  Google Scholar 

  9. Noori S, Friedlich P, Seri I, Wong P. Changes in myocardial function and hemodynamics after ligation of the ductus arteriosus in preterm infants. J Pediatr. 2007;150:597–602.

    Article  Google Scholar 

  10. McNamara PJ, Stewart L, Shivananda SP, Stephens D, Sehgal A. Patent ductus arteriosus ligation is associated with impaired left ventricular systolic performance in premature infants weighing less than 1000 g. J Thorac Cardiovasc Surg. 2010;140:150–7. Erratum in: J Thorac Cardiovasc Surg. 2010;140:944

    Article  Google Scholar 

  11. Noori S, McNamara P, Jain A, Lavoie PM, Wickremasinghe A, Merritt TA.PDA Ligation/Hypotension Trial Investigators et al. Catecholamine-resistant hypotension and myocardial performance following patent ductus arteriosus ligation. J Perinatol. 2015;35:123–7.

    Article  CAS  Google Scholar 

  12. Noori S, Friedlich P, Seri I, et al. Patent ductus arteriosus in the preterm infant: to treat or not to treat? J Perinatol. 2010;30:S31–S37.

    Article  Google Scholar 

  13. Ogando AR, Asensio IP, Sanchez de la blanca AR, Tejerizo FB, Luna MS, Jaurena JM, et al. Surgical ligation versus percutaneous closure of patent ductus arteriosus in very low-weight preterm infants: which are the real benefits of the percutaneous approach? Pediatr Cardiol. 2018;39:398–410.

    Article  Google Scholar 

  14. Higgins S, Friedlich P, Seri I. Hydrocortisone for hypotension and vasopressor dependence in preterm neonates: a meta-analysis. J Perinatol. 2010;30:373–8.

    Article  CAS  Google Scholar 

  15. Clyman RI, Wickremasinghe A, Merritt TA, Solomon T, McNamara P, Jain A, et al. Hypotension following patent ductus arteriosus ligation: the role of adrenal hormones. J Pediatr. 2014;164:1449–55.

    Article  CAS  Google Scholar 

  16. Bourchier, Weston PJ. Randomised trial of dopamine compared with hydrocortisone for the treatment of hypotensive very low birth weight infants. Arch Dis Child. 1997;76:F174–F178.

    Article  CAS  Google Scholar 

  17. Wang-Giuffre EW, Breinholt J. Novel use of the Medtronic micro vascular plug for PDA closure in preterm infants. Catheter Cardiovasc Int. 2017;89:1059–65.

    Article  Google Scholar 

  18. Sathanandam S, Justino H, Warrer BR 3rd, Radtke W, Qureshi AM. Initial clinical experience with the Medtronic Micro Vascular Plug in transcatehter occlusion of PDAs in extremely premature infants. Catheter Cardiovasc Int. 2017;89:1051–8.

    Article  Google Scholar 

  19. Pamukcu O, Tuncay A, Narin N, Baykan A, Korkmaz L, Argun M, et al. Patent ductus arteriosus closure in preterms less than 2 kg: surgery versus transcatheter. Int J Cardiol. 2018;250:110–5.

    Article  Google Scholar 

  20. Zahn EM, Peck D, Phillips A, nevin P, Basaker K, Simmons C, et al. Transcatheter closure of patent ductus arteriosus in extremely premature newborns early results and midterm-follow up. J Am Coll Cardiol Intv. 2016;9:2429–37.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge George Eckert and the Department of Biostatistics at Indiana University for their assistance in statistical analysis.

Author information

Authors and Affiliations

  1. Riley Hospital for Children, Department of Pediatric Cardiology, Indianapolis, IN, USA

    Ryan M. Serrano, Mackenzie Madison, Mark Hoyer & Ryan Alexy

  2. Riley Hospital for Children, Department of Neonatology, Indianapolis, IN, USA

    Diane Lorant & Ryan Alexy

Authors
  1. Ryan M. Serrano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mackenzie Madison
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Diane Lorant
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mark Hoyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ryan Alexy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ryan Alexy.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Serrano, R.M., Madison, M., Lorant, D. et al. Comparison of ‘post-patent ductus arteriosus ligation syndrome’ in premature infants after surgical ligation vs. percutaneous closure. J Perinatol 40, 324–329 (2020). https://doi.org/10.1038/s41372-019-0513-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-019-0513-8

This article is cited by

Search

Advanced search

Quick links