The impact of a dedicated patent ductus arteriosus ligation team on neonatal health-care outcomes

• Published in: Journal of perinatology 2016-06, Vol.36 (6), p.463-468
• Main Authors: Resende, M H F, More, K, Nicholls, D, Ting, J, Jain, A, McNamara, P J
• Format: Article
• Language: English
• Subjects: 631/443/1338; 631/443/592; Canada; Care and treatment; Complications and side effects; Congenital diseases; Coronary vessels; Decision making; Demographics; Demography; Ductus Arteriosus, Patent - diagnosis; Ductus Arteriosus, Patent - surgery; Echocardiography; Failure; Female; Gestational Age; Health aspects; Hospitals; Humans; Hypotension; Infant Health - standards; Infant, Newborn; Infants (Newborn); Intensive care; Ligation; Male; Mechanical ventilation; Medicine; Medicine & Public Health; Morbidity; Neonatal care; Neonates; Newborn babies; original-article; Outcome and Process Assessment (Health Care); Oxygenation; Patent ductus arteriosus; Patient Care Team - organization & administration; Patient Selection; Patients; Pediatric Surgery; Pediatrics; Perioperative Care - methods; Perioperative Care - standards; Physiology; Postoperative Complications - prevention & control; Quality Improvement; Subgroups; Surgery; Time-to-Treatment; Triage - organization & administration; Triage - standards; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - methods; Vascular Surgical Procedures - statistics & numerical data; Ventilation; Ventilators; Womens health
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/jp.2015.213

Objective: The decision to perform patent ductus arteriosus (PDA) ligation is controversial. Patient selection is oftentimes poorly standardized, leading to delays in referral and inappropriate intervention. A system for PDA ligation categorization and triaging process was introduced in 2006 at a quaternary hospital in Canada to streamline referrals and enhance perioperative care. We aimed to evaluate the impact of this dedicated PDA ligation triaging system comparing pre- and postimplementation of this system. Study Design: We performed a retrospective chart review. Demographic and cardiorespiratory data of neonates ⩽30 weeks gestation age at birth, who were referred for and/or had a PDA ligation performed during two distinct epochs (EPOCH 1 (2003 to 2005) and EPOCH 2 (2010 to 2012)), were analyzed. All surgeries were performed at The Hospital for Sick Children, the regional referral center for PDA ligation. The primary outcome was incidence of PDA ligation and procedural cancellations. Secondary outcomes included postoperative need for cardiovascular or respiratory support. Subgroup analysis was performed in neonates 1000 g at the time of surgery during both epochs. Result: A total of 198 neonates underwent surgery with no difference in baseline demographics between epochs. The incidence of PDA ligation as a proportion of total live births under 30 weeks in Central East Region of Ontario was lower in the second epoch (EPOCH 1: 117/1092 (10.7%) vs EPOCH 2: 81/1520 (5.3%)). During the second epoch, 24% of referrals for surgery were canceled after review by our PDA ligation team. There were no overall differences in the proportion of neonates with oxygenation failure, ventilation failure or Post-Ligation Cardiac Syndrome (PLCS), after surgery, between epochs. The proportion of neonates who developed systemic hypotension was higher in patients