Shirley A. Wilkerson

Developmental Sequelae in Premature Infants Undergoing Ligation of Patent Ductus Arteriosus

One hundred sixteen infants who underwent on-unit ligation of patent ductus arteriosus (PDA) were examined for developmental sequelae. Mean gestational age of the study group was 29.1 weeks; mean birth weight, 1,232 gm; and mean duration of follow-up, 20.7 months (chronological age). Seven infants died of severe bronchopulmonary dysplasia (4) and severe central nervous system dysfunction (3) before they were 3 years old. Sixty-five percent of the remaining infants exhibited normal motor and mental development, although 58% showed some degree of postnatal growth retardation. There was no evidence of left arm dysfunction caused by the thoracic incision; 3 infants had minor problems with nonabsorbed sutures at 3 to 6 months of age. No infant demonstrated recurrence of ductal patency. Mild sensorineural handicaps not expected to be of long-term importance were noted in 20 infants. Eighteen other infants (15.5%) were classified as having moderate to severe impairments, which may have substantial impact on development and ability to function. Surgical ligation of PDA in premature infants has been shown to be safe and effective in the short run. Long-term follow-up suggests that infants who undergo PDA ligation do not appear to be at increased risk for sensorineural handicaps.

1279 A COMPARISON OF FLUSH AORTOGRAPHY, ECHOCARDIOGRAPHY, AND PULSED DOPPLER IN THE DIAGNOSIS OF PDA

Morbidity and mortality in PDA is influenced by accuracy of diagnosis, early versus delayed treatment, and the complications of treatment and diagnostic methods. 68 premature infants less than 1200 gms with severe RDS were evaluated for PDA by clinical exam, flush aortography, echocardiography, and pulsed doppler. PDA was diagnosed in 42 infants(62%)surviving greater than 24 hours. 13 infants(19%)showed no evidence of PDA. A comparison of the accuracy of diagnostic methods in detecting ductal shunting revealed the following:The data show all three diagnostic tools to be highly accurate with a low degree of false negative results. Flush aortography was the most sensitive. Of the 5 patients with negative flush aortography, 3 had surgical confirmation of PDA, I showed a positive echo and doppler, and I was confirmed by clinical exam alone.

1278 THREE CLINICAL PATTERNS OF RDS-PDA IN VERY LOW BIRTHWEIGHT NEONATES (VLBW)

68 VLBW neonates (<1200 grams)with severe RDS(FiO2 requirement >.50, IMV and a positive CXR)were evaluated for a PDA by exam, echocardiography, pulsed doppler and flush aortography. 3 different clinical courses were noted. Group I(19% mean BW 888.7gms) demonstrated early irreversible CR failure and death within 24 hours despite attempts at medical closure of PDA with indomethacin(.2mg/kg po). Group II(62%)had severe RDS and PDA and medical or surgical ligation was performed in all of the neonates when the PDA was documented and deemed clinically significant. Group III(19%)had severe RDS without a documentable PDA. The overall study group survival was 59.9%. Survival in Groups II and III was 67% and 84.7% respectively. A comparison between these groups is listed below:The data show that the presence of RDS with or without PDA in VLBW neonates is associated with prolonged requirements of assisted ventilation and the development of BPD. However, a smaller group of VLBW neonates with severe RDS and PDA, despite early manipulation of the PDA will still succumb in less than 24 hours.