Predictors of Respiratory Improvement 1 Week after Ligation of Patent Ductus Arteriosus in Preterm Infants

Kai-Hsiang Hsu; Pierre Wong; S Ram Kumar; Julie Evans; Shahab Noori

doi:10.1016/j.jpeds.2018.09.061

Predictors of Respiratory Improvement 1 Week after Ligation of Patent Ductus Arteriosus in Preterm Infants

J Pediatr. 2019 Feb:205:49-54.e2. doi: 10.1016/j.jpeds.2018.09.061. Epub 2018 Oct 19.

Authors

Kai-Hsiang Hsu¹, Pierre Wong², S Ram Kumar³, Julie Evans⁴, Shahab Noori⁵

Affiliations

¹ Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA; Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan.
² Division of Cardiology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA.
³ Heart Institute, Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA.
⁴ Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA.
⁵ Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA. Electronic address: snoori@chla.usc.edu.

PMID: 30348438
DOI: 10.1016/j.jpeds.2018.09.061

Abstract

Objective: To characterize preterm infants that demonstrates respiratory improvement 7 days after ligation of a patent ductus arteriosus (PDA).

Study design: We performed a 2-phase study of preterm infants (birthweight <1500 g between 2010 and 2016). We first did a retrospective analysis using regression modeling of ligation population. We then performed a case-control study comparing a ligation group with infants matched by gestational age, postnatal age, and preligation respiratory condition (ventilator mode, mean airway pressure [MAP], and fraction of inspired oxygen [FiO₂]). Respiratory improvement was defined as either extubation, downgrading of ventilatory mode, reduction in MAP >25%, or decrease in FiO₂ >25%.

Results: Forty-five (42%) of 107 preterm infants (gestational age 25.5 ± 1.7 weeks) with ligation showed respiratory improvement at 7 days. Infants on high frequency ventilation (HFV) were more likely to have respiratory improvement (aOR 5.03, 95% CI [1.14-22.18]). In matched-control analysis of 89 pairs, there was no difference in respiratory improvement. Among infants on HFV, the ligation group had an increase in MAP during 3 days prior to ligation. For infants on conventional ventilation, the ligation group had higher MAP and FiO₂ than the control group during the first 2-3 postoperative days.

Conclusions: Among infants undergoing PDA ligation, those on HFV were more likely to have respiratory improvement in the first week, possibly because of the prevention of further respiratory deterioration. For infants on conventional ventilation, ligation was associated with higher respiratory support in the immediate postligation period without respiratory benefits at 7 days. As HFV was used as a rescue mode, our findings suggest that those with worse lung disease may achieve greater short term benefit from PDA ligation.

Keywords: high frequency ventilation; very low birth weight infants.

MeSH terms

Case-Control Studies
Ductus Arteriosus, Patent / complications
Ductus Arteriosus, Patent / surgery*
Female
Gestational Age
High-Frequency Ventilation / adverse effects*
Humans
Infant
Infant, Extremely Premature
Infant, Newborn
Infant, Very Low Birth Weight
Ligation / methods*
Male
Respiratory Insufficiency / etiology
Respiratory Insufficiency / prevention & control
Retrospective Studies
Risk Factors
Severity of Illness Index
Treatment Outcome