1
|
Gallardo-Meza AF, González-Sánchez JM, Vidrio-Patrón F, Velarde-Briceño IL, Peña-Juárez A, Murguía-Guerrero H, Martínez-González MT, Ceja-Mejía OE, Medina-Andrade MA, Armas-Quiroz P, Arias-Uribe BN, López-Villalobos E, Vázquez-Jackson H. [Effectiveness and safety of the surgical closure of permeable arteriosus conduct by the general pediatric surgeon: clinical trial]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2021; 91:73-83. [PMID: 33661880 PMCID: PMC8258916 DOI: 10.24875/acm.20000014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Antecedentes: El conducto arterioso permeable (CAP) es un defecto cardiaco congénito y se considera un problema de salud pública. Se presenta en un alto porcentaje de recién nacidos y en algunos mayores de 1 mes. El cierre farmacológico es el tratamiento inicial preferido, ya que ha tenido excelentes resultados; sin embargo, en aquellos casos en los que no es posible, está indicado el cierre quirúrgico. Objetivo: Evaluar la eficacia y la seguridad del cierre quirúrgico del CAP por cirujanos pediatras sin especialidad en cirugía cardiovascular. Método: Ensayo clínico realizado en pacientes del Hospital General de Occidente, centro hospitalario público de segundo nivel, con diagnóstico de CAP, que requirieron corrección quirúrgica. Se revisaron en forma retrospectiva los expedientes de enero de 2001 a diciembre de 2018. Resultados: Se incluyeron 224 pacientes divididos en dos grupos: grupo I, con 184 (82%) recién nacidos, y grupo II, con 40 (18%) niños grandes de 2 meses a 8 años de edad. A todos se les realizó cierre quirúrgico: 3 por toracoscopía y 221 por toracotomía posterolateral izquierda. Presentaron complicaciones 36 pacientes, lo que representa el 16% del total; solo el 5.3% fueron complicaciones mayores. Fallecieron 24 pacientes en el posoperatorio, lo que representa una mortalidad del 10.7%; ninguno falleció por complicaciones transquirúrgicas. El CAP es un defecto cardíaco congénito que se presenta en alto porcentaje en pacientes prematuros. El cierre farmacológico es el principal tratamiento por tener excelentes resultados en recién nacidos; sin embargo, en aquellos casos en los que no sea posible está indicado el cierre quirúrgico. Todos los pacientes fueron operados por cirujanos pediatras generales, con una sobrevida global del 92%. Conclusiones: En los hospitales donde no hay cirujano cardiovascular pediátrico ni cardiólogo intervencionista, la corrección quirúrgica del CAP puede ser llevada a cabo por un cirujano pediatra. La técnica es reproducible, fácil de realizar y con mínimas complicaciones.
Collapse
Affiliation(s)
- Antonio F Gallardo-Meza
- Departamento de Cirugía Pediátrica. Hospital General de Occidente, Hospital Santa María Chapalita, Guadalajara, Jalisco, México
| | - José M González-Sánchez
- Departamento de Cirugía Pediátrica. Hospital General de Occidente, Hospital Santa María Chapalita, Guadalajara, Jalisco, México
| | - Francisco Vidrio-Patrón
- Departamento de Cirugía Pediátrica. Hospital General de Occidente, Hospital Santa María Chapalita, Guadalajara, Jalisco, México
| | - Irene L Velarde-Briceño
- Departamento de Cirugía Pediátrica. Hospital General de Occidente, Hospital Santa María Chapalita, Guadalajara, Jalisco, México
| | - Alejandra Peña-Juárez
- Departamento de Cardiología Pediátrica. Hospital General de Occidente, Hospital Santa María Chapalita, Guadalajara, Jalisco, México
| | - Humberto Murguía-Guerrero
- Departamento de Cirugía Pediátrica. Hospital General de Occidente, Hospital Santa María Chapalita, Guadalajara, Jalisco, México
| | | | - Oscar E Ceja-Mejía
- Unidad de Cuidados Intensivos Neonatales. Hospital General de Occidente, Hospital Santa María Chapalita, Guadalajara, Jalisco, México
| | - Miguel A Medina-Andrade
- Departamento de Cirugía Pediátrica. Hospital General de Occidente, Hospital Santa María Chapalita, Guadalajara, Jalisco, México
| | - Paulina Armas-Quiroz
- Unidad de Cuidados Intensivos Neonatales. Hospital General de Occidente, Hospital Santa María Chapalita, Guadalajara, Jalisco, México
| | - Brenda N Arias-Uribe
- Unidad de Cuidados Intensivos Neonatales. Hospital General de Occidente, Hospital Santa María Chapalita, Guadalajara, Jalisco, México
| | - Elizabeth López-Villalobos
- Unidad de Cuidados Intensivos Neonatales. Hospital General de Occidente, Hospital Santa María Chapalita, Guadalajara, Jalisco, México
| | - Humberto Vázquez-Jackson
- Departamento de Cirugía Pediátrica. Hospital General de Occidente, Hospital Santa María Chapalita, Guadalajara, Jalisco, México
| |
Collapse
|
2
|
A comparison of postoperative outcomes with PDA ligation in the OR versus the NICU: a retrospective cohort study on the risks of transport. BMC Anesthesiol 2018; 18:199. [PMID: 30579349 PMCID: PMC6303951 DOI: 10.1186/s12871-018-0658-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 12/03/2018] [Indexed: 12/04/2022] Open
Abstract
Background Although patent ductus arteriosus (PDA) ligations in the Neonatal Intensive Care Unit (NICU) have been an accepted practice, many are still performed in the Operating Room (OR). Whether avoiding transport leads to improved perioperative outcomes is unclear. Here we aimed to determine whether PDA ligations in the NICU corresponded to higher risk of surgical site infection or mortality and if transport was associated with worsened perioperative outcomes. Methods We performed a retrospective cohort study of NICU patients, ≤37 weeks post-menstrual age, undergoing surgical PDA ligation in the NICU or OR. We excluded any infants undergoing device PDA closure. We measured the incidence of perioperative hypothermia, cardiac arrest, decreases in SpO2, hemodynamic instability and postoperative surgical site infection, sepsis and mortality. Results Data was collected on 189 infants (100 OR, 89 NICU). After controlling for number of preoperative comorbidities, weight at time of procedure, procedure location and hospital in the mixed-effect model, no significant difference in mortality or sepsis was found (odds ratio 0.31, 95%CI 0.07, 1.30; p = 0.107, and odds ratio 0.40; 95%CI 0.14, 1.09; p = 0.072, respectively). There was an increased incidence of hemodynamic instability on transport postoperatively in the OR group (12.4% vs 2%, odds ratio 6.93; 95% CI 1.48, 35.52; p = 0.014). Conclusion PDA ligations in the NICU were not associated with higher incidences of surgical site infection or mortality. There was an increased incidence of hemodynamic instability in the OR group on transport back to the NICU. Larger multicenter studies following long-term outcomes are needed to evaluate the safety of performing all PDA ligations in the NICU. Keywords Patent ductus arteriosus, Newborn infant, Neonatal intensive care unit, Surgical wound infection, Postoperative period, Hemodynamics
Collapse
|
3
|
Noonan M, Turek JW, Dagle JM, McElroy SJ. Intraoperative High-Frequency Jet Ventilation Is Equivalent to Conventional Ventilation During Patent Ductus Arteriosus Ligation. World J Pediatr Congenit Heart Surg 2017; 8:570-574. [DOI: 10.1177/2150135117717974] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Patent ductus arteriosus (PDA) treatment is typically pharmacologic, but if unsuccessful, surgical ligation is commonly performed. High-frequency jet ventilation (HFJV) is used at the University of Iowa Stead Family Children’s Hospital for extremely low birth weight infants. Historically, neonates requiring PDA ligation were temporarily transferred to conventional ventilation (CV) prior to surgery. Objective: The objective of this study was to determine whether conversion was necessary. Methods: This retrospective cohort analysis examined outcomes following PDA ligation from 2014 to 2016 at the University of Iowa’s Stead Family Children’s Hospital. Infants who were transferred to CV prior to surgery and returned to HFJV postprocedure are referred to as the CV cohort. The HFJV cohort infants remained on HFJV throughout. Results: We found no significant increases in morbidity or mortality with the use of intraoperative HFJV and potentially show some benefit through greater reduction in serum CO2. Conclusions: Mode of ventilation during PDA ligation does not affect surgical morbidity or mortality or short-term clinical outcomes. Conversion to CV from HFJV is not necessary.
Collapse
Affiliation(s)
- Mackenzie Noonan
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Joseph W. Turek
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
- Department of Surgery, University of Iowa, Iowa City, IA, USA
| | - John M. Dagle
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Steven J. McElroy
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
4
|
Outcomes of primary ligation of patent ductus arteriosus compared with secondary ligation after pharmacologic failure in very-low-birth-weight infants. Pediatr Cardiol 2014; 35:793-7. [PMID: 24370764 PMCID: PMC4015055 DOI: 10.1007/s00246-013-0854-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 11/28/2013] [Indexed: 11/03/2022]
Abstract
This study aimed to determine whether primary surgical closure of patent ductus arteriosus (PDA) is a risk factor for morbidity and mortality compared with secondary surgical ligation. The study enrolled 178 very-low-birth-weight infants. The surgical group included 34 patients who did not respond to pharmacologic intervention and eventually required ligation of their PDA as well as 35 patients who underwent direct ligation because of contraindications to the use of oral ibuprofen. The overall outcomes for the primary and secondary ligation groups were compared. The outcome during hospitalization showed no statistically significant difference in terms of morbidity and mortality between the two groups. The group that had primary ligation for PDA experienced more complications associated with premature birth such as lower gestational age and birth weight. The two groups did not differ significantly in terms of overall outcomes.
Collapse
|
5
|
Patent ductus arteriosus in preterm infants: Benefits of early surgical closure. Asian Cardiovasc Thorac Ann 2013; 22:391-6. [DOI: 10.1177/0218492313480051] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Patent ductus arteriosus in preterm neonates leads to significant morbidity. Surgery is indicated when pharmacological treatment fails or is contraindicated, but the optimal timing remains unclear. Methods We retrospectively studied all 41 preterm neonates with symptomatic ductus arteriosus who underwent ligation between 1988 and 2009. We compared early complications rates and late neurological outcomes of patients operated on before 21 days of age with these operated on later. Results The median gestational age at birth was 26 weeks (range 23–31 weeks) and median weight at birth was 930 g (range 510–1500 g); 34 (82.9%) received pharmacological treatment before surgery. Fourteen (34.1%) patients underwent surgical closure before 21 days of age and 27 (65.9%) after 21 days. The 2 groups did not differ significantly in gestational age and weight at birth, but those operated on after 21 days received significantly more pharmacological treatment cycles. Patients in the early closure group had shorter intubation times: median 23 days (range 13–35 days) vs. 43 days (range 27–84 days; p < 0.001) and shorter neonatal intensive care unit stay: median 44 days (range 31–66 days) vs. 76 days (range 41–97 days; p < 0.001), with significantly lower rates of bronchopulmonary dysplasia, intraventricular hemorrhage, and acute renal failure, and significantly better neurological outcomes. Discussion Performing early ligation of symptomatic ductus arteriosus after unsuccessful pharmacological therapy in preterm neonates might lower complication rates and improve neurological outcome. Prospective randomized studies are needed to determine the optimal treatment.
Collapse
|
6
|
Tantraworasin A, Woragidpoonpol S, Chuaratanapong S, Sittiwangkul R, Chittawatanarat K. Timing of surgical closure of patent ductus arteriosus in preterm neonates? Asian Cardiovasc Thorac Ann 2012; 20:12-8. [PMID: 22371936 DOI: 10.1177/0218492311430356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A retrospective cohort study was conducted on 115 preterm neonates who underwent patent ductus arteriosus ligation after failure of medical treatment, at Chiang Mai University Hospital between January 2003 and December 2010. Two groups were defined: an early surgery group (39.1%) treated with surgical closure within 21 days, and a late surgery group (60.9%) operated on >21 days after birth. There were significant differences between the 2 groups in terms of weight at surgery, birth weight, duration of intubation, ductal size, and preoperative indomethacin usage. The early surgery group had a longer intensive care unit stay, but differences in postoperative chronic lung disease, ductal size, and surfactant use were not significant. Babies with a low birth weight (<1,500 g) and those with a higher ductal gradient were more susceptible to chronic lung disease, but multivariate analysis showed no difference between early and late surgery patients in either early extubation or chronic lung disease. It was concluded that early patent ductus arteriosus ligation did not show more benefits than late surgery.
Collapse
Affiliation(s)
- Apichat Tantraworasin
- Division of Cardiovascular-Thoracic Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | | | | | | | | |
Collapse
|
7
|
Ghallab A, El-Gohary Y, Redmond M, Corbally M. In-situ emergency pediatric surgery in the intensive care unit. Ir J Med Sci 2012; 182:33-6. [PMID: 22528250 DOI: 10.1007/s11845-012-0819-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The role of surgery in the intensive care unit (ICU) remains unclear. Although previous studies have not shown any increase in morbidity when operating on patients in the ICU for surgical procedures; there remains a reluctance to operate on sick patients in the ICU. AIM We did a retrospective study of critically ill children and neonates who underwent in-situ surgery (ISS) to further evaluate its safety and potential. Surgery was aided with the use of operative loupes and high-intensity headlight. METHODS The medical records of all patients who had undergone surgical procedures in the pediatric ICU over an 11-year period from January 1998 till December 2008 were retrospectively reviewed. We reviewed our experience looking specifically at wound infection rates along with other morbidities in 543 patients. RESULTS Our morbidities were comparable with that of operations performed in the operating theater, with low wound infection rates (1%) for all surgeries undertaken in the pediatric ICU. CONCLUSION ISS avoids the risks of transfer to the operative theater and the potential delays in theater access. Our results suggest that ISS in a tertiary-level pediatric surgical hospital is safe and does not impact adversely on clinical outcome.
Collapse
Affiliation(s)
- A Ghallab
- Division of Pediatric Surgery, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland.
| | | | | | | |
Collapse
|
8
|
Yoo HS, Kim JE, Park SK, Seo HJ, Jeong YJ, Chio SH, Jeong SI, Kim SH, Yang JH, Huh J, Chang YS, Jun TG, Kang IS, Park WS, Park PW, Lee HJ. Clinical course and prognosis of hemodynamically significant congenital heart defects in very low birth weight infants. KOREAN JOURNAL OF PEDIATRICS 2009. [DOI: 10.3345/kjp.2009.52.4.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hye Soo Yoo
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Eun Kim
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Kyoung Park
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Ju Seo
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoo Jin Jeong
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seo Heui Chio
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo In Jeong
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Hoon Kim
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hyuk Yang
- Department of thoracic and cardiovascular surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - June Huh
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun Sil Chang
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Gook Jun
- Department of thoracic and cardiovascular surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - I Seok Kang
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Soon Park
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pyo Won Park
- Department of thoracic and cardiovascular surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heung Jae Lee
- Department of pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
9
|
Surgical Ligation of Patent Ductus Arteriosus in Very-low-birth-weight Premature Infants in the Neonatal Intensive Care Unit. J Formos Med Assoc 2009; 108:69-71. [DOI: 10.1016/s0929-6646(09)60034-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
10
|
Golombek S, Sola A, Baquero H, Borbonet D, Cabañas F, Fajardo C, Goldsmit G, Lemus L, Miura E, Pellicer A, Pérez J, Rogido M, Zambosco G, van Overmeire B. Primer consenso clínico de SIBEN: enfoque diagnóstico y terapéutico del ductus arterioso permeable en recién nacidos pretérmino. An Pediatr (Barc) 2008. [DOI: 10.1157/13128002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
11
|
Lee GY, Sohn YB, Kim MJ, Jeon GW, Shim JW, Chang YS, Huh J, Kang IS, Yang JH, Jun TG, Park PW, Park WS, Lee HJ. Outcome following surgical closure of patent ductus arteriosus in very low birth weight infants in neonatal intensive care unit. Yonsei Med J 2008; 49:265-71. [PMID: 18452264 PMCID: PMC2615315 DOI: 10.3349/ymj.2008.49.2.265] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE The aims of this study were to determine the factors affecting the outcome of patent ductus arteriosus ligation in very low birth weight infants (VLBWI) and demonstrate the safety of PDA ligation in VLBWI performed in the neonatal intensive care unit (NICU). MATERIALS AND METHODS From October 1994 to July 2006, medical records of 94 VLBWI weighing <1,500 g who underwent PDA ligation in the NICU of Samsung Medical Center were reviewed retrospectively. Factors affecting the final outcome of PDA ligation were evaluated by dividing the infants into 3 groups according to mortality and major morbidities as follows: mortality group (Mo), major morbidity group (Mb), and no major morbidity group (NM). RESULTS In the Mo group, birth weight was significantly lower and the preoperative mean FiO2 and mean dopamine dose were significantly higher than those in the other 2 groups. There was no significant difference in gestational age, incidence of RDS, number of courses of indomethacin, surgery-related factors, including weight and age at surgery, perioperative vital signs, and complications after surgery between the 3 groups. During surgery in the NICU, there were no significant hemodynamic instability or serious acute complications. CONCLUSION The factors affecting the outcome of surgery in VLBWI are not the factors related to surgery but the preoperative conditions related to the underlying prematurity. PDA ligation of VLBWI performed in the NICU is safe without serious complications.
Collapse
Affiliation(s)
- Ga Yeun Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bae Sohn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myo Jing Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ga Won Jeon
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Won Shim
- Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - June Huh
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - I-Seok Kang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Hyuk Yang
- Department of Thoracic and Cordiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae-Gook Jun
- Department of Thoracic and Cordiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pyo Won Park
- Department of Thoracic and Cordiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Soon Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heung Jae Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
12
|
Mallick MS, Jado AM, Al-Bassam AR. Surgical procedures performed in the neonatal intensive care unit on critically ill neonates: feasibility and safety. Ann Saudi Med 2008; 28:105-8. [PMID: 18398286 PMCID: PMC6074523 DOI: 10.5144/0256-4947.2008.105] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Transferring unstable, ill neonates to and from the operating room carries significant risks and can lead to morbidity. We report on our experience in performing certain procedures in critically ill neonates in the neonatal intensive care unit (NICU). We examined the feasibility and safety of such an approach. METHODS All surgical procedures performed in the the NICU between January 1999 and December 2005 were analyzed in terms of demographic data, diagnosis, preoperative stability of the patient, procedures performed, complications and outcome. Operations were performed at bedside in the NICU in critically ill, unstable neonates who needed emergency surgery, in neonates of very low birth weight (<1000 g) and in neonates on special equipment like high frequency ventilators and nitrous oxide. RESULTS Thirty-seven surgical procedures were performed including 12 laparotomies, bowel resections and stomies, 7 repairs of congenital diaphragmatic hernias, 4 ligations of patent ductus arteriosus, and various others. Birthweights ranged between 850 g and 3500 g (mean, 2000 g). Gestational age ranged between 25 to 42 weeks (mean, 33 weeks). Age at surgery was between 1 to 30 days (mean, 10 days). Preoperatively, 19 patients (51.3%) were on inotropic support and all were intubated and mechanically ventilated. There was no mortality related to surgical procedures. Postoperatively, one patient developed wound infection and disruption. CONCLUSION Performing major surgical procedures in the the NICU is both feasible and safe. It is useful in very low birth weight, critically ill neonates who have a definite risk attached to transfer to the operating room. No special area is needed in the the NICU to perform complication-free surgery, but designing an operating room within the the NICU would be ideal.
Collapse
|
13
|
Lee CS, Shinn HK, Lim HK, Song JH, Jung JK, Han JU, Cho BK. Anesthetic Management of Early Ligation of Patent Ductus Arteriosus for Premature Infants in the Neonatal Intensive Care Unit. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.54.1.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Choon Soo Lee
- Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea
| | - Helen Ki Shinn
- Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea
| | - Hyun Kyoung Lim
- Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea
| | - Jang Ho Song
- Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea
| | - Jong Kwon Jung
- Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea
| | - Jung Uk Han
- Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea
| | - Byung Kwon Cho
- Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea
| |
Collapse
|
14
|
Intraoperative Macroscopic Lung Appearance in Premature Infants with Body Weights Less than 1000 G Undergoing Surgical Treatment for PDA. POLISH JOURNAL OF SURGERY 2007. [DOI: 10.2478/v10035-007-0093-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
15
|
Jaillard S, Larrue B, Rakza T, Magnenant E, Warembourg H, Storme L. Consequences of Delayed Surgical Closure of Patent Ductus Arteriosus in Very Premature Infants. Ann Thorac Surg 2006; 81:231-4. [PMID: 16368371 DOI: 10.1016/j.athoracsur.2005.03.141] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Revised: 03/07/2005] [Accepted: 03/16/2005] [Indexed: 11/23/2022]
Abstract
BACKGROUND Surgical closure of ductus arteriosus is commonly indicated in premature newborns. The aim of this study was to assess short-term and mid-term effects of delayed surgical closure of the ductus arteriosus on respiratory and digestive outcome in extremely preterm infants. METHODS We retrospectively studied 58 infants less than 28 weeks gestational age who underwent surgical closure of ductus arteriosus between January 1997 and December 2002. Nine infants with intrauterine growth restriction and major congenital malformation were excluded from the study. Criteria for surgical closure of ductus arteriosus were: (1) medical treatment failure (ie, indomethacin or ibuprofen) and (2) hemodynamically patent ductus arteriosus: systemic arterial pressure less than gestational age in mm Hg, heart failure, left atrial-aortic root ratio greater than 1.6, mean velocity in the left pulmonary artery greater than 0.6 m/s, and ductus arteriosus diameter greater than 3 mm. Infants were divided into two groups: (1) the early group who had surgery before 21 days of life (n = 31), and (2) the late group who had surgery after 21 days of life (n = 27). Preoperative and postoperative criteria were compared between the two groups (ie, gestational age, birth weight, hemodynamic, ventilatory, and echographic [left atrial-aortic root ratio, mean velocity in the left pulmonary artery] parameters). RESULTS Preoperative gestational age and birth weight did not differ between the two groups. In the early group, gestational age was 26 weeks (range, 23 to 28 weeks and birth weight was 800 g (range, 630 to 1,240 g). In the late group, gestational age was 26 weeks (range, 24 to 28 weeks) and birth weight was 840 g (530 to 1,130 g). Hemodynamic, ventilatory, and echographic parameters were similar in both groups. Rate of bronchopulmonary dysplasia was similar in both groups. However, at 24 hours post surgery, median FiO2 was higher in the late group (28% [range, 21% to 65%]) than in early group (21% [range, 21% to 60%]) (p < 0.05). Furthermore, full oral feeding was acquired later in the late group (57 days of life [range, 30 to 136 days]) than in the early group (37 days of life [range, 27 to 84 days]) (p < 0.01), and body weight at 36 weeks of post-conceptional age was higher in the early group at 1,800 g (range, 1,250 to 2,750 g) than in the late group at 1,607 g (1,274 to 2,200 g) (p < 0.05). CONCLUSIONS Our findings show that early surgical closure of the ductus arteriosus (< 3 weeks of life) is associated with shortened delay for full oral feeding and improved body growth when compared with late surgical closure (> 3 weeks of life).
Collapse
|
16
|
Gould DS, Montenegro LM, Gaynor JW, Lacy SP, Ittenbach R, Stephens P, Steven JM, Spray TL, Nicolson SC. A comparison of on-site and off-site patent ductus arteriosus ligation in premature infants. Pediatrics 2003; 112:1298-301. [PMID: 14654600 DOI: 10.1542/peds.112.6.1298] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Persistent patent ductus arteriosus (PDA) often produces hemodynamic and respiratory derangement necessitating use of inotropic drugs and escalating ventilatory support in premature infants. When medical therapy fails, surgical ligation is indicated. Because of the risks of transferring unstable neonates to the operating room, ductal ligation is routinely performed at the neonatal intensive care unit (NICU) bedside. Some patients, however, require transfer from hospitals without pediatric cardiac surgical teams. In an attempt to eliminate the risks associated with transfer, a surgical team from our institution offered to perform duct ligation in the NICUs of referring institutions. This experienced team consisted of a pediatric cardiac attending anesthesiologist and certified registered nurse anesthetist, cardiac operating room nurses, an attending cardiothoracic surgeon, and a cardiothoracic surgery fellow. We retrospectively reviewed our experience. METHODS After approval from the Committee for the Protection of Human Subjects, the charts of premature neonates who underwent PDA ligation in the NICU at the Children's Hospital of Philadelphia NICU or in a network NICU between January 1996 and April 2002 were reviewed. Data abstracted included institution, gender, gestational age, birth weight, weight at surgery, and number of courses of indomethacin. Mean arterial blood pressure and use of inotropic drugs and ventilatory parameters (fraction of inspired oxygen, peak inspiratory pressure) were recorded at the time of surgery and 96 hours postoperatively. Perioperative complications were recorded. RESULTS Seventy-two patients met the criteria for inclusion. PDA ligation was performed in the Children's Hospital of Philadelphia NICU in 38 of 72 patients, 53% (group 1). The remainder, 34 of 72 (47%) underwent PDA ligation in the NICU at 1 of 6 referring institutions (group 2). There were no significant differences between groups with respect to demographics, number of courses of indomethacin, or use of inotropic drugs or ventilatory support. The incidence of perioperative complications did not differ between groups: 3 in group 1 (bleeding, chylothorax, and pleural effusion) and 3 in group 2 (pneumothorax [3]). There were no anesthetic-related complications. Seven patients died (4 in group 1 and 3 in group 2), none within 96 hours of surgery and none secondary to the procedure. DISCUSSION The data demonstrate that an experienced team can perform PDA ligation safely in NICUs of hospitals without on-site pediatric cardiac surgical capabilities in critically ill neonates without incurring the risks inherent in patient transport. Most importantly, patient care is continued by the neonatology team most familiar with the infant's medical and social history, and the patient's family is minimally inconvenienced.
Collapse
Affiliation(s)
- Douglas S Gould
- Division of Cardiothoracic Anesthesia, Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Knight DB. The treatment of patent ductus arteriosus in preterm infants. A review and overview of randomized trials. SEMINARS IN NEONATOLOGY : SN 2001; 6:63-73. [PMID: 11162286 DOI: 10.1053/siny.2000.0036] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patent ductus arteriosus (PDA) is a common problem in very preterm infants. It results in a significant left-to-right shunt and an increase in left ventricular output. Pulmonary compliance can be reduced. Systemic effects result from the diastolic steal and retrograde diastolic blood flow. Randomized controlled trials of PDA closure fall into three groups: (i) prophylactic treatment in the first 24 h, (ii) pre-symptomatic treatment on ultrasound evidence of a PDA or the first clinical signs and (iii) treatment when it becomes haemodynamically significant. Prophylactic treatment with indomethacin reduces the incidence of intraventricular haemorrhage. All the trials have a decreased need to treat a subsequent PDA in the treatment group. There are no other improvements in outcome, without any change in mortality, bronchopulmonary dysplasia, necrotizing enterocolitis or retinopathy of prematurity. Clinical decisions on the treatment of the ductus should be individualized and based on the gestation of the baby, the respiratory condition and the size of the ductal shunt.
Collapse
Affiliation(s)
- D B Knight
- Newborn Services, National Women's Hospital, Claude Road, Auckland, New Zealand.
| |
Collapse
|
18
|
Li SS, Xu SA, Zheng YR, Zhao XW. Surgical Interruption of Patent Ductus Arteriosus in Children. Asian Cardiovasc Thorac Ann 1998. [DOI: 10.1177/021849239800600107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
From January 1981 to September 1996, 447 patients with patent ductus arteriosus (122 male and 325 female) aged from 0.75 to 14 years, underwent surgery in our institute. Systolic blood pressure was maintained below 90 mm Hg with sodium nitroprusside and a vertical incision was made under the left axilla through the third intercostal space. Simple ligation was performed when the ductus was less than 10 mm in diameter. In 313 patients with a patent ductus arteriosus of 10 mm diameter or greater, a Dacron cushion was placed under the ligature. There was no death or evidence of residual patency. We recommend careful control of systolic blood pressure during the whole procedure and the use of a cushion under the ligature when closing a large ductus.
Collapse
Affiliation(s)
- Shu Sen Li
- Department of Cardiac Surgery The Second Clinical College, China Medical University Shenyang, People's Republic of China
| | - Si An Xu
- Department of Cardiac Surgery The Second Clinical College, China Medical University Shenyang, People's Republic of China
| | - You Ren Zheng
- Department of Cardiac Surgery The Second Clinical College, China Medical University Shenyang, People's Republic of China
| | - Xi Wu Zhao
- Department of Cardiac Surgery The Second Clinical College, China Medical University Shenyang, People's Republic of China
| |
Collapse
|
19
|
Laborde F, Folliguet TA, Etienne PY, Carbognani D, Batisse A, Petrie J. Video-thoracoscopic surgical interruption of patent ductus arteriosus. Routine experience in 332 pediatric cases. Eur J Cardiothorac Surg 1997; 11:1052-5. [PMID: 9237586 DOI: 10.1016/s1010-7940(97)00093-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Pediatric video-assisted thoracic surgery closure of patent ductus arteriosus can now be performed on a routine basis. We review here our entire experience with this technique. METHODS Three hundred and thirty two consecutive patients underwent video-assisted closure of patent ductus arteriosus from September 1991 to September 1996. Indications were symptomatic ductus or failure of closure in older children. All complications were carefully noted, as well as intensive care unit stay, and operating room time. RESULTS Patients were divided in three age groups: less than 6 months (101 patients, 31%), 6-48 months (179 patients, 54%), greater than 48 months (52 patients, 16%). The mean weight was 12.6 kg (range 1.2-65 kg). Associated cardiac anomalies were atrial septal defect (3), ventricular septal defect (5), anomalous pulmonary venous return (1). Six patients had a residual shunt following video-assisted interruption. Five patients had successful immediate clip repositioning (three via video-assisted interruption, two via thoracotomy). One patient continued to have a small shunt, which is followed medically. Complications included recurrent laryngeal nerve dysfunction in six patients (1.8%) (five transient, one persistent). Mean operating time was 20 +/- 1.5 mn and hospital stay averaged 48 h (> 6 months), 72 h (< 6 months). CONCLUSIONS Interruption of patent ductus can be safely performed by video-assisted technique with minimal morbidity and no mortality. It can be performed in all age group with minimal hospital stay.
Collapse
Affiliation(s)
- F Laborde
- L'Institut Mutualiste Montsouris, Paris, France
| | | | | | | | | | | |
Collapse
|
20
|
Gavilanes AW, Heineman E, Herpers MJ, Blanco CE. Use of neonatal intensive care unit as a safe place for neonatal surgery. Arch Dis Child Fetal Neonatal Ed 1997; 76:F51-3. [PMID: 9059188 PMCID: PMC1720621 DOI: 10.1136/fn.76.1.f51] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIM To evaluate the advantages, disadvantages, and short term morbidity and mortality of major surgical interventions performed in the neonatal intensive care unit. METHODS A retrospective case review of 45 neonates was performed from April 1991 to September 1995. The characteristics of the patients were: gestational age 29 (SD 4) weeks (range 24 to 41 weeks); birth-weight 1305 (870) g (range 540 to 4040 g); presurgical weight 1430 (895) g (range 550 to 4370 g); postconceptional age at surgery 31 (4) weeks (26 to 47 weeks). The indications for surgery were: ligation of patent ductus arteriosus (n = 16); insertion of a subcutaneous ventricular catheter reservoir for hydrocephalus (n = 14); repair of congenital diaphragmatic hernia (n = 2); open lung biopsy (n = 1); and laparotomies (because of necrotising enterocolitis, anorectal malformations, and intestinal obstructions) (n = 12). The management of these neonates at laparotomy was: bowel resection with stomas (n = 8) and stomas (n = 4). No specially designed area was used to perform surgery. RESULTS Local or systemic infection associated with surgery was not seen and no perioperative mortality was related to the surgical procedure. CONCLUSIONS The neonatal intensive care unit is suitable for major surgery during the neonatal period and no special area is needed to perform complication free surgery.
Collapse
Affiliation(s)
- A W Gavilanes
- Department of Neonatology, University Hospital Maastricht, The Netherlands
| | | | | | | |
Collapse
|
21
|
Robie DK, Waltrip T, Garcia-Prats JA, Pokorny WJ, Jaksic T. Is surgical ligation of a patent ductus arteriosus the preferred initial approach for the neonate with extremely low birth weight? J Pediatr Surg 1996; 31:1134-7. [PMID: 8863249 DOI: 10.1016/s0022-3468(96)90102-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The optimal approach to a patent ductus arteriosus (PDA) in an extremely low birth weight (ELBW) neonate, whether initial surgical ligation or a trial of indomethacin, has not been established. The authors reviewed the records of 82 ELBW premature infants who had surgical ligation of a PDA during a 2-year period. Thirty-one received indomethacin before ligation. Bronchopulmonary dysplasia (BPD) occurred in 33% of the infants. Predictors of BPD were prolonged positive pressure ventilation, severe intraventricular hemorrhage (IVH) and lower birth weight (BW). Seventy-seven percent of the infants survived. Predictors of mortality were severe IVH, lower BW, and the occurrence of necrotizing enterocolitis (NEC). The indomethacin-treated infants had a lower incidence of NEC and IVH. Overall, 16% of the patients had perioperative morbidity, and 10% of the patients died. The study shows that a trial of indomethacin therapy is not associated with increased complications in ELBW infants with PDA.
Collapse
Affiliation(s)
- D K Robie
- Section of Pediatric Surgery, Cora and Webb Mading Department of Surgery, Texas Children's Hospital, Houston 77030, USA
| | | | | | | | | |
Collapse
|
22
|
Laborde F, Folliguet T, Batisse A, Dibie A, da-Cruz E, Carbognani D. Video-assisted thoracoscopic surgical interruption: the technique of choice for patent ductus arteriosus. Routine experience in 230 pediatric cases. J Thorac Cardiovasc Surg 1995; 110:1681-4; discussion 1684-5. [PMID: 8523880 DOI: 10.1016/s0022-5223(95)70031-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Video-assisted thoracoscopic surgical interruption for patient ductus arteriosus is a well-standardized procedure already described. We present our entire series of such cases, from the first case (performed on Sept. 5, 1991) to March 1, 1995. Two hundred thirty patients in a variety of age groups underwent video-assisted interruption: younger than 6 months (70 patients, 30%), 6 to 48 months (123 patients, 54%), and older than 48 months (37 patients, 16%). The mean weight was 12.6 kg (range 1.2 to 65 kg). Thirty-nine patients had symptomatic pulmonary hypertension. Associated intracardiac anomalies included atrial septal defect (three), ventricular septal defect (five), and anomalous pulmonary venous return (one). All patients underwent video-assisted interruption of the patient ductus arteriosus with two titanium clips. Closure was evaluated by postoperative echocardiography before extubation. Five patients had a persistent patent ductus after video-assisted interruption, all early in our experience and related to insufficient dissection resulting in inadequate clip placement. Four patients had successful immediate clip repositioning (three by video-assisted interruption and one by thoracotomy). Subsequent echocardiography revealed persistent closure in these patients. A persistent patent ductus arteriosus with minimal flow was discovered in one patient without symptoms after discharge. Recurrent laryngeal nerve dysfunction was noted in six patients (2.6%, five transient and one persistent). There were no deaths, hemorrhages, transfusions required, or chylothoraces in this series. Mean operative time was 20 +/- 15 minutes, and hospital stay averaged 48 hours for patients younger than 6 months and 72 hours for patients older than 6 months. This is a safe, rapid, cost-effective technique that results in excellent results and a shortened hospital stay. Video-assisted interruption represents the technique of choice for closure of a patient ductus arteriosus.
Collapse
Affiliation(s)
- F Laborde
- Department of Cardio-pediatric Surgery, Centre Médico-Chirurgical de la Porte de Choisy, Paris, France
| | | | | | | | | | | |
Collapse
|
23
|
Liang CD, Su WJ. Aneurysm of the aortic sinus of Valsalva with reversed shunt of ductus arteriosus. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1995; 34:333-6. [PMID: 7621545 DOI: 10.1002/ccd.1810340213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A rare case of aneurysm of aortic sinus of Valsalva associated with patent ductus arteriosus and Eisenmenger's syndrome in a 7-yr-old boy is described. The diagnosis was made by echocardiography and cardiac angiography.
Collapse
Affiliation(s)
- C D Liang
- Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | | |
Collapse
|
24
|
Boonkasem S, Pongpanich B, Tejavei A. Surgical Closure of Patent Ductus Arteriosus in Infants Weighing Less than 2.5kg. Asian Cardiovasc Thorac Ann 1995. [DOI: 10.1177/021849239500300104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Persistent heart failure is a major problem in low birth weight infants with patent ductus arteriosus (PDA). There is a considerable incidence of renal insufficiency and reopening of the ductus after pharmacologic closure. Surgical closure of symptomatic PDA should therefore be indicated to avoid morbidity or mortality from heart failure and renal failure. Between March 1990 and December 1993 there were 33 low birth weight infants who underwent surgical closure of PDA, ranging in age from 5 to 90 days (mean = 25) with 15 males and 18 females (M:F = 1:1.2). The patients were classified into 3 groups: group 1 (< 1000gm) 11 cases, group 2 (1000-1499gm) 10 cases, group 3 (1500-2499gm) 12 cases. The indications for surgical closure of PDA included: persistent heart failure in 28, renal insufficiency in 20, reopening of the ductus after pharmacologic closure in 16 and growth failure in 1. The early mortality was 6% (2/33). Both of them were in group 1: one from necrotizing enterocolitis (NEC), and one from cytomegalovirus (CMV) infection on the 6th and 20th postoperative day respectively. Late death occurred twice: the first case in group 1 from sepsis 35 days postoperatively, and the second in group 2 from pneumonia 3 months after surgery. The causes of late mortality in both cases were not related to surgery. The 29 survivors are doing reasonably well during follow-up period.
Collapse
Affiliation(s)
| | | | - Anant Tejavei
- Division of Neonatology, Department of Pediatrics Ramathibodi Hospital Medical School Bangkok, Thailand
| |
Collapse
|
25
|
Affiliation(s)
- N Archer
- Department of Paediatrics, John Radcliffe Hospital, Headington, Oxford
| |
Collapse
|
26
|
Abstract
The critically ill neonate with a surgical condition requires transfer to an operating room (OR), a process which may be associated with significant morbidity. In an effort to reduce such morbidity, we performed surgery on critically ill neonates in a designated area of our neonatal intensive care unit (NICU) over the past 4 years and have compared the outcome for infants operated on within the NICU with infants operated on in the OR over the same period. There were 81 procedures performed in the NICU compared with 112 in the OR. Infants operated on in the NICU had lower birthweights (1,758 g v 2,457 g), lower gestational ages (31.3 weeks v 35.8 weeks), and lower presurgical weights (2,118 g v 2,922 g) (all P < .0001). In addition, infants operated on in the NICU had a greater severity of illness with 78% requiring mechanical ventilation versus 26% for the OR group (P < .0001) with a higher presurgical FiO2 (.43 v .31, P = .005), and a higher presurgical mean airway pressure (8.0 cm H2O v 6.2 cm H2O) for infants requiring mechanical ventilation. The overall mortality was higher in the NICU group (14% v 2%), reflecting their underlying prematurity, illness, and anomalies. There was only one surgically related death, which occurred in the NICU group. There was no significant difference in culture-proven sepsis, length of surgery, change in weight, temperature, blood pressure, heart rate, FiO2, mean airway pressure, or oxygen index associated with surgery, but there was a significantly higher incidence of hyperthermia with a temperature of greater than 37.5 degrees C in the OR group (17.8% v 3.7%, P = .002). Our experience suggests that surgical procedures can be performed in the NICU for the unstable critically ill neonate with a morbidity comparable to that seen in the OR. Further experience is needed to compare the risks and benefits of this approach.
Collapse
Affiliation(s)
- N N Finer
- Department of Newborn Medicine, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | | | | | | |
Collapse
|