6799 Indication and outcome of PDA ligation in preterm babies in a tertiary neonatal unit over 5 years

Objectives To review the incidence and indication of PDA ligation, alongside the outcome and complications. Methods Retrospective data analysis was conducted from Badger Net (electronic documentation) and case notes. We analysed patient characteristics, indications, clinical profile and outcome of babies who underwent PDA ligation over 5 years (Jan2018-Dec2022). Babies who received only medical management were excluded. Results Over 5 years, 200 babies had a PDA, of which eight babies underwent PDA ligation. The mean gestation at birth was 27+6 weeks (mean birth weight 1161 grams). The mean gestation at PDA ligation was 35 weeks (mean weight 1981g). All babies who underwent ligation received medical treatment (table 1). All babies had serial echocardiograms pre and post medication. The mean PDA size pre-surgical ligation was 2.8 mm with haemodynamic significance in 62.5% (table 2). The indication for PDA ligation was ventilator dependence (4 babies), dependence on non-invasive ventilatory support (3 babies) and recurrent pulmonary edema/haemorrhage (1 baby). All babies were transferred by the local transport team. Following PDA ligation, four babies experienced complications (2 pneumothoraces, one pulmonary hypertension and a vocal cord palsy). One baby died within 28 days of the PDA ligation. Respiratory support was weaned (over mean duration of 3.5 days post PDA ligation) to low flow oxygen for 2 babies and to air for 5 babies at discharge. Conclusion Neonatal units are becoming more conservative with PDA management. It is reassuring to note that PDA ligation is uncommon on our NICU, with only 1–2 babies per year undergoing ligation. A 50% complication rate was noted with pneumothorax being the commonest. We note good outcome with 62.5% babies being discharged home on no oxygen support (mean duration of weaning from respiratory support post-ligation being 3.5 days). Reassuringly, the incidence of PDA ligation in our NICU of 3.3% is comparable to a national rate of 2.1% as per the National GIRFT review.