Journal article
Predictors of respiratory instability in neonates undergoing patient ductus arteriosus ligation after the introduction of targeted milrinone treatment
The Journal of thoracic and cardiovascular surgery, Vol.152(2), pp.498-504
08/2016
DOI: 10.1016/j.jtcvs.2016.03.085
PMID: 27174516
Abstract
The postoperative course of preterm babies undergoing surgical closure of a patent ductus arteriosus (PDA) is often complicated by postligation cardiac syndrome (PLCS). Despite targeted milrinone prophylaxis, some infants continue to experience postoperative respiratory deterioration. Our objective is to describe the immediate postoperative course and identify risk factors for respiratory instability when preterm infants undergoing PDA ligation are managed with targeted milrinone treatment.
A retrospective review of a cohort of infants undergoing PDA ligation between January, 2010 and August, 2013 was conducted. All infants had a targeted neonatal echocardiogram performed 1 hour after surgery. Infants received prophylactic milrinone treatment if the left ventricular output was <200 mL/kg/min. The primary outcome measure was the development of respiratory instability within 24 hours of surgery. Multivariable logistic regression was performed to identify predictors of respiratory instability.
Eighty-six infants with a median gestational age of 25 weeks (interquartile range [IQR], 24-26) and a birth weight of 740 g (IQR, 640-853) were included in this study. Forty-nine (57.0%) received milrinone prophylaxis. There were 44 (51.2%) infants who developed oxygenation or ventilation failure, and 7 (8.1%) neonates developed PLCS. Infants with longer isovolumic relaxation time (IVRT ≥30 milliseconds) were more likely to develop either oxygenation or ventilation failure.
Although the incidence of PLCS has declined after the introduction of targeted milrinone prophylaxis, many preterm infants continue to develop respiratory instability after surgical ligation. In this population, diastolic dysfunction manifested by prolonged IVRT could be associated with an adverse postoperative respiratory course.
Details
- Title: Subtitle
- Predictors of respiratory instability in neonates undergoing patient ductus arteriosus ligation after the introduction of targeted milrinone treatment
- Creators
- Joseph Y Ting - Department of Pediatrics, University of British Columbia, Vancouver, CanadaMaura Resende - Department of Pediatrics, University of Toronto, Toronto, CanadaKiran More - Department of Pediatrics, University of Toronto, Toronto, CanadaDonna Nicholls - Department of Pediatrics, University of Toronto, Toronto, CanadaDany E Weisz - Department of Pediatrics, University of Toronto, Toronto, CanadaAfif EL-Khuffash - Department of Neonatology, The Rotunda Hospital, Dublin, IrelandAmish Jain - Department of Pediatrics, University of Toronto, Toronto, CanadaPatrick J McNamara - Department of Pediatrics, University of Toronto, Toronto, Canada
- Resource Type
- Journal article
- Publication Details
- The Journal of thoracic and cardiovascular surgery, Vol.152(2), pp.498-504
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.jtcvs.2016.03.085
- PMID
- 27174516
- ISSN
- 0022-5223
- eISSN
- 1097-685X
- Language
- English
- Date published
- 08/2016
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology; Internal Medicine
- Record Identifier
- 9984093471602771
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