IS SURGICAL LIGATION OF A PATENT DUCTUS-ARTERIOSUS THE PREFERRED INITIAL APPROACH FOR THE NEONATE WITH EXTREMELY LOW-BIRTH-WEIGHT

The optimal approach to a patent ductus arteriosus (PDA) in an extreme ly low birth weight (ELBW) neonate, whether initial surgical ligation or a trial of indomethacin, has not been established. The authors revi ewed the records of 82 ELBW premature infants who had surgical ligatio n of a PDA during a 5-year period. Thirty-one received indomethacin be fore ligation. Bronchopulmonary dysplasia (BPD) occurred in 33% of the infants. Predictors of BPD were prolonged positive pressure ventilati on, severe intraventricular hemorrhage (IVH) and lower birth weight (B W). Seventy-seven percent of the infants survived. Predictors of morta lity were severe IVH, lower BW, and the occurrence of necrotizing ente rocolitis (NEC). The indomethacin-treated infants had a lower incidenc e of NEC and IVH. Overall, 16% of the patients had perioperative morbi dity, and 10% of the patients died. The study shows that a trial of in domethacin therapy is not associated with increased complications in E LBW infants with PDA. Copyright (C) 1996 by W.B. Saunders Company.