# Radiographic Characterization of Rib Structural Deformity Following Surgical Patent Ductus Arteriosus Clipping in Preterm Infants

## TL;DR

This study finds that preterm infants who undergo surgical PDA clipping may develop rib deformities, especially if they didn't receive NSAIDs beforehand or have retinopathy of prematurity.

## Contribution

The study identifies new associations between preoperative NSAID use, retinopathy of prematurity, and rib deformities following PDA clipping in preterm infants.

## Key findings

- Rib deformities occurred in 6 out of 28 preterm infants after PDA ligation.
- Infants with rib deformities had lower preoperative NSAID use and higher rates of retinopathy of prematurity.
- Deformities were more common in younger infants at the time of surgery.

## Abstract

Background: The effect of patent ductus arteriosus (PDA) ligation through clipping on rib structural integrity in preterm infants is not yet fully elucidated. This study aimed to analyze radiographically evident rib deformity in preterm infants following PDA ligation and identify factors associated with these modifications.

Methods: This retrospective observational study enrolled preterm infants (gestational age <37 weeks) who underwent PDA ligation through left posterolateral thoracotomy between January 2014 and December 2022. Two radiologists, blinded to the clinical data, independently evaluated serial plain chest radiographs obtained before and after the surgical intervention.

Results: Of the 46 preterm infants with PDA requiring surgical ligation, 28 met the inclusion criteria. Six patients exhibited radiographic rib deformity following the procedure (rib alteration cohort), whereas 22 exhibited no such changes (control cohort). The structural modifications predominantly affected the left third through sixth ribs. Although no significant intergroup differences were observed in gestational age, birthweight, sex, antenatal corticosteroid administration, cumulative nonsteroidal anti-inflammatory drug (NSAID) doses, chronological age at surgery, operative duration, or incidence of postoperative complications, the rib deformity cohort demonstrated significantly lower utilization of preoperative NSAIDs (P = 0.04) and significantly higher prevalence of retinopathy of prematurity requiring intervention at discharge (P < 0.01). In addition, the corrected gestational age at surgical intervention tended to be younger in the cohort with rib deformities than in controls (P = 0.05).

Conclusion: Rib structural deformity represents a common phenomenon in preterm infants who did not receive NSAIDs before PDA ligation and those with retinopathy of prematurity. Furthermore, these modifications tended to occur in infants with a younger corrected gestational age at the time of surgical intervention.