Risk factors associated with prolonged mechanical ventilation after surgical ligation of patent ductus arteriosus in very low birth weight infants in China: a single-center study

Background In developing countries, surgical ligation continues to be the primary approach for managing patent ductus arteriosus (PDA) in premature infants, owing to its simplicity, feasibility in resource-constrained environments, and proven effectiveness. The aim of our study is to investigate the risk factors associated with prolonged mechanical ventilation following surgical ligation of PDA in very low birth weight infants (VLBWIs) in China. Methods A retrospective analysis was conducted on the clinical data of VLBWIs who underwent PDA ligation surgery between January 1,2022 and December 30,2024. The infants were divided into two groups based on the duration of mechanical ventilation following ligation: those with mechanical ventilation ≤ 7 days and those with prolonged mechanical ventilation > 7 days. The perioperative clinical characteristics, preoperative echocardiographic changes, postoperative complications, and mortality rates were compared between two groups. Risk factors associated with prolonged mechanical ventilation after ligation were analyzed. Results A total of 47 VLBWIs were enrolled over a three-year period. 34 cases (72%) were successfully extubated within 7 days, while 13 cases (28%) experienced prolonged mechanical ventilation after ligation. Statistically significant differences were observed between the two groups in terms of preoperative left ventricular end-diastolic diameter, peak systolic velocity, proportion of preoperative and postoperative respiratory severity score/weight > 3, proportion of postoperative oxygenation index > 10, inhaled oxygen concentration, inotrope score, oxygen partial pressure, and mortality rate ( p  < 0.05). Binary logistic regression analysis showed that patients with more severe preoperative lung disease (RSS/kg > 3 and/or moderate to severe bronchopulmonary dysplasia (BPD)) were more prone to postoperative mechanical ventilator dependency. Conclusion VLBWIs with more severe lung disease before PDA ligation, characterized by RSS/kg > 3 and/or moderate to severe BPD, were more likely to experience postoperative ventilator dependence.