Abstract:
Background: Temporal derangements in oxygenation and ventilation have been associated with surgical ligation and device closure of the ductus arteriosus. We sought to evaluate respiratory decompensation, defined as an increase of Respiratory Severity Score (RSS) >50% above pre-procedural value following surgical ligation (SL) or transcatheter PDA closure (TCPC). Methods: Premature infants <37 weeks gestational age who underwent invasive mechanical ventilation before and after PDA closure were included in the study. Included infants were grouped according to procedure type (SL or TCPC) and need for rescue high-frequency ventilation (HFV). RSS> 50% above baseline and HFV usage were measured at six intervals, from admission through 24-hours post-procedure. The Mann-Whitney U-test was used to assess differences in continuous variables and the chi-square and Fisher exact tests were utilized for categorical variables. The Holm-Sidak procedure was used to correct for multiple comparisons. Results: 110 infants, (n = 88) SL and (n = 22) TCPC were included for analysis. Twelve-hours post-procedure RSS> 50% was observed in 40% of SL compared to 3% of TCPC (p = .021) and rescue HFV at 24-hours was (42% vs. 5%, p = .004) for SL and TCPC respectively. Rescue HFV was associated with SL (92% vs. 8%, p = .008), smaller gestational age (25 vs. 26 weeks, p = .003) and younger age at PDA closure (19 vs. 25 days, p = .003). Conclusion: In this study, we found that respiratory decompensation following closure of the PDA was associated with younger gestational age, younger age at PDA closure, surgical ligation, and elevated RSS values over the first 12 hours after closure. These results confirm prior data, but also suggest that an elevated RSS following PDA closure may be a useful non-invasive bedside tool to identify the respiratory phenotype of post ligation cardiac syndrome.
