BPSU - Surgical Ligation of the Patent Ductus Arteriosus in Premature Babies

Surveillance of surgical ligation of the patent ductus arteriosus concluded its surveillance period in September 2013 and is in the process of collecting and analysing data. The study is being led by Dr Lleona Lee, winner of the Sir Peter Tizard Bursary 2008-09.

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LLeona and Wilf.JPG

Lead investigator

Dr Lleona Lee

Neonatal Consultant
Neonatal Unit, Nottingham City Hospital Campus
Nottingham University Hospitals NHS Trust
Hucknall Road

Nottingham, NG5 1PB

Tel: 0115 969 1169

Email: lleona.lee@nuh.nhs.uk

Overview

  • This UK study aims to describe the incidence of surgical ligation of the patent ductus arteriosus (PDA) in premature babies born at less than 37 weeks gestation.
  • The ductus arteriosus is a normal connection between the pulmonary artery and the aorta in the fetus which usually closes after birth. In premature babies the ductus arteriosus can remain open and is then called a patent ductus arteriosus (PDA).
  • The abnormal flow of blood through the PDA causes haemodynamic effects including diastolic steal from the systemic circulation and increased pulmonary blood flow. It has been associated with chronic lung disease, necrotising enterocolitis, retinopathy of prematurity and intraventricular haemorrhage. It can also cause symptoms of cardiac failure and poor growth.
  • Because of these haemodynamic effects and clinical associations, closure of the PDA may be clinically indicated.
  • First line treatment is usually with medical treatment with non-steroidal antiinflammatory drugs such as ibuprofen or indomethacin. If medical treatment is contraindicated or not successful, a small minority of premature babies are referred for surgical ligation of their PDA.
  • Those who undergo surgical ligation are likely to be a sicker cohort of babies, with symptoms judged to be related their PDA, who have not responded to medical treatment or are too sick to have medical treatment. They are therefore an important group to study.

Case definition: Any baby born at less than 37 completed weeks of gestation, with no other structural cardiac abnormality, who, during the past month, has unergone surgical ligation of a patent ductus arteriosus before first discharge to home. Plase note that a patent foramen ovale is not considered a structural cardiac abnormality.

Duration: September 2012 to September 2013 (13 months of surveillance)

Funding: Sir Peter Tizard Bursary, British Paediatric Surveillance Unit

Ethical approval: This study has been approved by NRES Committee - East Midlands – Derby (REC reference 12/EM/0149) and has been granted Section 251 NIGB permission under reference: ECC 3-02(FT6)/2012

Further information