SURGICAL CLOSURE OF HEMODYNAMICALLY SIGNIFICANT PDA IN VERY LOW BIRTH WEIGHT PRETERM NEONATE: A CASE REPORT AND LITERATURE REVIEW
Surgical PDA Closure in VLBW Preterm Neonate
Keywords:
large patent ductus arteriosus, very low birth weight, premature infant, surgical ligationAbstract
Background: Patent ductus arteriosus (PDA) is a common problem in preterm neonates, particularly when it is hemodynamically significant or "large" in size. Its persistence may result in severe cardiopulmonary and systemic compromise.
Case Presentation: We present a case of a neonate born at 27 weeks’ gestation weighing 1150 grams, diagnosed with a large PDA (4 mm) and associated septal defects. The patient had severe comorbidities including neonatal sepsis due to multidrug-resistant (MDR) organisms, pneumonia, malnutrition, congenital hypothyroidism, and suspected Hirschsprung disease. Medical management was contraindicated, and surgical ligation was performed at day 34 via posterolateral thoracotomy. Postoperative recovery was marked by improvement in hemodynamics, respiratory status, and nutritional tolerance. Patient was discharged 44 days after surgery in stable condition and grew well.
Conclusion: This case illustrates the clinical benefit and safety of surgical PDA ligation in a critically ill, extremely preterm infant when pharmacologic options are not viable. Timely intervention and multidisciplinary care were crucial in achieving a favorable outcome.
Keywords: large patent ductus arteriosus, very low birth weight, premature infant, surgical ligation
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References
McNamara PJ, Sehgal A. Patent ductus arteriosus: to treat or not to treat? J Clin Neonatol. 2014;3(2):67–74.
Noori S. Patent ductus arteriosus in the preterm infant. Semin Perinatol. 2012;36(2):123–9.
El-Khuffash A, McNamara PJ. Neonatologist-performed functional echocardiography in the NICU. J Perinatol. 2011;31(10):673–81.
Singh Y, Tissot C, Fraga MV, Yousef N, Cortes RG, Lopez J, et al. International evidence-based guidelines on point of care ultrasound (POCUS) for critically ill neonates and children. Intensive Care Med. 2020;46(4):593–606.
Ohlsson A, Shah PS. Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight (or both) infants. Cochrane Database Syst Rev. 2020;(2):CD003481.
Chock VY, Ramamoorthy C, Van Meurs KP, Hintz SR. Patent ductus arteriosus ligation and adverse neurodevelopmental outcomes: a pre-post study. JAMA Pediatr. 2017;171(3):e164354.
Zahir ST, Niknafs P, Nariman S. Outcome following patent ductus arteriosus ligation in premature infants. BMC Pediatr. 2006;6:15.
Weisz DE, Mirea L, Rosenberg E, Schmölzer GM, Kelly EN, Gournay V, et al. Outcomes of extremely low gestational age neonates with persistent patent ductus arteriosus. Arch Dis Child Fetal Neonatal Ed. 2019;104(3):F290–6.
Roze JC, Cambonie G, Marchand-Martin L, Gournay V, Durrmeyer X, Durox M, et al. Association between early surgical closure of patent ductus arteriosus and neonatal outcomes. J Pediatr. 2015;166(6):1428–32.e2.
Sellmer A, Bjerre JV, Schmidt MR, McNamara PJ, Hjortdal VE, Host B, et al. Morbidity and mortality associated with patent ductus arteriosus in premature infants. Neonatology. 2011;99(1):16–23.
Sathanandam S, Gutfinger D, O’Brien L, Forbes TJ, Gillespie MJ, Berman DP, et al. Initial experience with transcatheter closure of patent ductus arteriosus in extremely low birth weight infants. Catheter Cardiovasc Interv. 2019;93(1):89–96.
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