Is surgical closure of patent ductus arteriosus a safe procedure in premature infants?

Despite indomethacin therapy many premature infants require surgical closur e of their patent ductus arteriosus (PDA). Between January 1985 and Decembe r 1997, 176 premature infants underwent surgical closure of PDA by vascular clip after failure of medical treatment. The median gestational age and bi rth weight were 26 weeks (range 23-36 weeks) and 847.5 g (range 400-2300 g) , respectively The median age at diagnosis and at surgery nas 4 days (range , 1-37) and 21 days (range, 4-60) respectively. The median weight at surger y was 982.5 g (range 475-2740 g), Of these infants, 168 (95%) were intubate d prior to surgery and the median time to extubation was 21 days (range 1-2 73 days). There were no operative deaths but II infants (6.4%) died from co mplications of prematurity (sepsis, bronchopulmonary dysplasia and pulmonar y hemorrhage), The frequency of chest tube insertion at surgery decreased f rom 41.7% to 10% between the 1985-88 and 1996-97 periods (P < 0.01), Three infants (1.7%) developed vocal cord paralysis directly related to the posit ion of the vascular clip. Echocardiography confirmed PDA closure in 43 infa nts (24.4%) while the remaining 133 had no clinical signs of PDA, Surgical closure of PDA by vascular clip carries a very low morbidity in premature i nfants.