Is surgical ligation of a patent ductus arteriosus the preferred initial approach for the neonate with extremely low birth weight?
Journal of Pediatric Surgery
indomethacin; Patent ductus arteriosus
The optimal approach to a patent ductus arteriosus (PDA) in an extremely low birth weight (ELBW) neonate, whether initial surgical ligation or a trial of indomethacin, has not been established. The authors reviewed the records of 82 ELBW premature infants who had surgical ligation of a PDA during a 2- year period. Thirty-one received indomethacin before ligation. Bronchopulmonary dysplasia (BPD) occurred in 33% of the infants. Predictors of BPD were prolonged positive pressure ventilation, severe intraventricular hemorrhage (IVH) and lower birth weight (BW). Seventy-seven percent of the infants survived. Predictors of mortality were severe IVH, lower BW, and the occurrence of necrotizing enterocolitis (NEC). The indomethacin-treated infants had a lower incidence of NEC and IVH. Overall, 16% of the patients had perioperative morbidity, and 10% of the patients died. The study shows that a trial of indomethacin therapy is not associated with increased complications in ELBW infants with PDA.
Robie, D., Waltrip, T., Garcia-Prats, J., Pokorny, W., Jaksic, T., & Guzzetta, P. (1996). Is surgical ligation of a patent ductus arteriosus the preferred initial approach for the neonate with extremely low birth weight?. Journal of Pediatric Surgery, 31 (8). http://dx.doi.org/10.1016/S0022-3468(96)90102-5