{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T15:40:54Z","timestamp":1779205254030,"version":"3.51.4"},"reference-count":10,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2003,12,1]]},"abstract":"<jats:p>Introduction. Persistent patent ductus arteriosus (PDA) often produces hemodynamic and respiratory derangement necessitating use of inotropic drugs and escalating ventilatory support in premature infants. When medical therapy fails, surgical ligation is indicated. Because of the risks of transferring unstable neonates to the operating room, ductal ligation is routinely performed at the neonatal intensive care unit (NICU) bedside. Some patients, however, require transfer from hospitals without pediatric cardiac surgical teams. In an attempt to eliminate the risks associated with transfer, a surgical team from our institution offered to perform duct ligation in the NICUs of referring institutions. This experienced team consisted of a pediatric cardiac attending anesthesiologist and certified registered nurse anesthetist, cardiac operating room nurses, an attending cardiothoracic surgeon, and a cardiothoracic surgery fellow. We retrospectively reviewed our experience.<\/jats:p>\n               <jats:p>Methods. After approval from the Committee for the Protection of Human Subjects, the charts of premature neonates who underwent PDA ligation in the NICU at the Children\u2019s Hospital of Philadelphia NICU or in a network NICU between January 1996 and April 2002 were reviewed. Data abstracted included institution, gender, gestational age, birth weight, weight at surgery, and number of courses of indomethacin. Mean arterial blood pressure and use of inotropic drugs and ventilatory parameters (fraction of inspired oxygen, peak inspiratory pressure) were recorded at the time of surgery and 96 hours postoperatively. Perioperative complications were recorded.<\/jats:p>\n               <jats:p>Results. Seventy-two patients met the criteria for inclusion. PDA ligation was performed in the Children\u2019s Hospital of Philadelphia NICU in 38 of 72 patients, 53% (group 1). The remainder, 34 of 72 (47%) underwent PDA ligation in the NICU at 1 of 6 referring institutions (group 2). There were no significant differences between groups with respect to demographics, number of courses of indomethacin, or use of inotropic drugs or ventilatory support. The incidence of perioperative complications did not differ between groups: 3 in group 1 (bleeding, chylothorax, and pleural effusion) and 3 in group 2 (pneumothorax [3]). There were no anesthetic-related complications. Seven patients died (4 in group 1 and 3 in group 2), none within 96 hours of surgery and none secondary to the procedure.<\/jats:p>\n               <jats:p>Discussion. The data demonstrate that an experienced team can perform PDA ligation safely in NICUs of hospitals without on-site pediatric cardiac surgical capabilities in critically ill neonates without incurring the risks inherent in patient transport. Most importantly, patient care is continued by the neonatology team most familiar with the infant\u2019s medical and social history, and the patient\u2019s family is minimally inconvenienced.<\/jats:p>","DOI":"10.1542\/peds.112.6.1298","type":"journal-article","created":{"date-parts":[[2004,8,14]],"date-time":"2004-08-14T00:43:47Z","timestamp":1092444227000},"page":"1298-1301","source":"Crossref","is-referenced-by-count":58,"title":["A Comparison of On-Site and Off-Site Patent Ductus Arteriosus Ligation in Premature Infants"],"prefix":"10.1542","volume":"112","author":[{"given":"Douglas S.","family":"Gould","sequence":"first","affiliation":[{"name":"Divisions of Cardiothoracic Anesthesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa M.","family":"Montenegro","sequence":"additional","affiliation":[{"name":"Divisions of Cardiothoracic Anesthesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. William","family":"Gaynor","sequence":"additional","affiliation":[{"name":"Cardiothoracic Surgery"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzanne P.","family":"Lacy","sequence":"additional","affiliation":[{"name":"Divisions of Cardiothoracic Anesthesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Ittenbach","sequence":"additional","affiliation":[{"name":"Cardiology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Stephens","sequence":"additional","affiliation":[{"name":"Biostatistics and Epidemiology, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James M.","family":"Steven","sequence":"additional","affiliation":[{"name":"Divisions of Cardiothoracic Anesthesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas L.","family":"Spray","sequence":"additional","affiliation":[{"name":"Cardiothoracic Surgery"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan C.","family":"Nicolson","sequence":"additional","affiliation":[{"name":"Divisions of Cardiothoracic Anesthesia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2003,12,1]]},"reference":[{"key":"2021121003460772600_R1","doi-asserted-by":"crossref","unstructured":"Uchita S, Imai Y, Takanashi Y, et al. Surgical management of patent ductus arteriosus in low body weight infants. Jpn J Thorac Cardiovasc Surg.1998;46:1088\u20131092","DOI":"10.1007\/BF03217881"},{"key":"2021121003460772600_R2","doi-asserted-by":"crossref","unstructured":"Van de Bor M, Verloove-Vanhorick SP, Brand R, Ruys, JH. Patent ductus arteriosus in a cohort of 1338 preterm infants: a collaborative study. Paediatr Perinat Epidemiol.1988;2:328\u2013336","DOI":"10.1111\/j.1365-3016.1988.tb00227.x"},{"key":"2021121003460772600_R3","unstructured":"Shenassa H, Sankaran K, Duncan W, Tyrrell M, Bharadwaj, B. Surgical ligation of patent ductus arteriosus in a neonatal intensive care unit is safe and cost effective. Can J Cardiol.1986;2:353\u2013355"},{"key":"2021121003460772600_R4","doi-asserted-by":"crossref","unstructured":"Hubbard C, Rucker RW, Realyvasquez F, et al. Ligation of the patent ductus arteriosus in newborn respiratory failure. J Pediatr Surg.1986;21:3\u20135","DOI":"10.1016\/S0022-3468(86)80639-X"},{"key":"2021121003460772600_R5","doi-asserted-by":"crossref","unstructured":"Taylor RL, Grover FL, Harmon PK, et al. Operative closure of patent ductus arteriosus in the neonatal intensive care unit. Am J Surg.1986;152:704\u2013708","DOI":"10.1016\/0002-9610(86)90453-8"},{"key":"2021121003460772600_R6","doi-asserted-by":"crossref","unstructured":"Coster DP, Gorton ME, Grooters K, et al. Surgical closure of the patent ductus arteriosus in the neonatal intensive care unit. Ann Thorac Surg.1989;48:386\u2013389","DOI":"10.1016\/S0003-4975(10)62863-9"},{"key":"2021121003460772600_R7","doi-asserted-by":"crossref","unstructured":"Miles MS, Funk SG, Kasper MA. The neonatal intensive care unit environment: sources of stress for parents. AACN Clin Issues Crit Care Nurs.1991;2:346\u2013354","DOI":"10.4037\/15597768-1991-2022"},{"key":"2021121003460772600_R8","unstructured":"Shields-Poe D, Pinelli J. 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