Ligation of medically refracted patent ductus arteriosus (PDA) in an extremely low body weight premature infant

Medically refracted patent ductus arteriosus (PDA) in an extremely low birt h weight (ELBW) preterm (gestation 24 weeks 2 days) infant was successfully ligated under general anesthesia in the neonatal intensive care unit (NICU ). Pharmacological agents are more effective to close PDA in preterm infant s than in full-term infants, although within 48 h three doses of indomethac in were not sufficient to close PDA in this case. At the age of 69 h the in fant developed severe symptoms including bradycardia, systemic hypotension, pulmonary hypertension, diastolic steal (reverse distal aorta Bow velocity ), and anuria. A PDA ligation was thus performed surgically at 72 h of age. General anesthesia and surgical stress were tolerated by this 531 g infant . Postoperatively all symptoms improved dramatically and the general condit ions were stable. On the 38th day the endotracheal tube was extubated and o n the 50th day nasogastric milk feeding was started, The oxygen supply was weaned on the 78th day. Growth and development until 6 months were within t he normal range of very low birth weight infants. A surgical ligation as ea rly as possible in medically refracted PDA in an ELBW infant is thus consid ered to be a safe and effective treatment. It prevents the development of f urther complications of cardiopulmonary vascular problems. Color Doppler ec hocardiography can reliably measure the PDA size, flow velocity, and hemody namic changes of persistent PDA, even in tiny infants.