Tohoku J. Exp. Med., 2016 September, 240(1)

Surgical Ligation for Patent Ductus Arteriosus in Extremely Premature Infants: Strategy to Reduce their Risk of Neurodevelopmental Impairment

SATOKO ITO,¹ TADASHI MATSUDA,¹ HARUO USUDA,¹ SHIMPEI WATANABE,¹ RYUTA KITANISHI,¹ TAKUSHI HANITA,¹ TATSUYA WATANABE¹ and OSAMU ADACHI²

¹Center for Perinatal-Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
²Department of Cardiovascular Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan

Surgical ligation for patent ductus arteriosus (PDA) in extremely low birth weight infants (ELBWIs) has been shown a possible association with neurodevelopmental impairment (NDI) because of its invasiveness. However, we have undergone surgical ligation for ELBWIs immediately after cyclooxygenase inhibitor failed to close a hemodynamically significant PDA (hsPDA) to maintain proper systemic circulation. We aimed to determine the effect of surgical ligation for hsPDA on NDI in ELBWIs. In enrolled 71 ELBWIs, the clinical parameters, including the developmental quotient (DQ), were collected and compared among three groups that were divided by closure mode: spontaneous closure (n = 11), cyclooxygenase inhibitor therapy (n = 37) and surgical ligation (n = 23). No significant differences in DQ at the age of 36 months among the three groups were found: Median (interquartile range): 92.0 (31.0), 89.0 (22.0) and 92.0 (24.5), respectively. In a comparison between groups of DQ < 70 (n = 15) and DQ ≥ 70 (n = 56), a significant difference was found in the parameters related to prematurity (p < 0.05 for each): gestational age [23.9 (1.70) vs. 25.4 (2.50) weeks], birth weight [595 (183) vs. 714 (192) g], Apgar score < 5 (1 min) (67% vs. 36%), and laser photocoagulation for retinopathy of prematurity (73% vs. 43%), but there was no significant association with hsPDA. Therefore, we propose that surgical ligation for hsPDA in ELBWIs should be immediately carried out for preventing future neurodevelopmental deterioration if the cyclooxygenase inhibitor failed to close hsPDA.

keywords —— cyclooxygenase inhibitor; developmental quotient; hemodynamically significant patent ductus arteriosus; Kyoto scale of psychological development 2001; neurodevelopmental impairment

© 2016 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2016, 240, 7-13

Correspondence: Tadashi Matsuda, Center for Perinatal-Neonatal Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.

e-mail: choku@med.tohoku.ac.jp