Changing patterns of patent ductus arteriosus surgical ligation in the United States.

Reese J, Scott TA, Patrick SW
Semin Perinatol. 2018 42 (4): 253-261

PMID: 29954594 · PMCID: PMC6512985 · DOI:10.1053/j.semperi.2018.05.008

Optimal management of patent ductus arteriosus (PDA) is unclear. One treatment, surgical ligation, is associated with adverse outcomes. We reviewed data from the Kids' Inpatient Database (2000-2012) to determine if PDA ligation rates: (1) changed over time, (2) varied geographically, or (3) influenced surgical complication rates. In 2012, 47,900 infants <1500g birth weight were born in the United States, including 2,800 undergoing PDA ligation (5.9%). Ligation was more likely in infants <1000g (85.9% vs. 46.2%), and associated with necrotizing enterocolitis (59.2% vs. 37.5%), BPD (54.6% vs. 15.2%), severe intraventricular hemorrhage (16.4% vs. 5.3%), and hospital transfer (37.6% vs. 16.4%). Ligation rates peaked in 2006 at 87.4 per 1000 hospital births, dropping to 58.8 in 2012, and were consistently higher in Western states. Infants undergoing ligation were more likely to experience comorbidities. Rates of ligation-associated vocal cord paralysis increased over time (1.2-3.9%); however, mortality decreased (12.4-6.5%). Thus, PDA ligation has become less frequent, although infants being ligated are smaller and more medically complex. Despite increase in some complications, mortality rates improved perhaps reflecting advances in care.

Copyright © 2018 Elsevier Inc. All rights reserved.

MeSH Terms (16)

Cerebral Intraventricular Hemorrhage Cross-Sectional Studies Ductus Arteriosus, Patent Enterocolitis, Necrotizing Female Humans Infant, Extremely Low Birth Weight Infant, Newborn Infant, Very Low Birth Weight Ligation Male Practice Patterns, Physicians' Retrospective Studies Treatment Outcome United States Vocal Cord Paralysis

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