SURGICAL LIGATION OF PATENT DUCTUS-ARTERIOSUS IN VERY-LOW-BIRTH-WEIGHT INFANTS - IS IT SAFE

We evaluated the outcome of a combined medical and surgical treatment of patent ductus arteriosus (PDA) in newborns weighing less than 1500 g. Charts were retrospectively reviewed for 76 newborns with a PDA bet ween 1993 and 1997. Thirteen infants had pre-existing conditions prohi biting the use of indomethacin; eight were managed surgically, five me dically. The remaining 63 infants received indomethacin therapy. Thirt y-two medical failures occurred, requiring surgical ligation of the PD A. Those requiring surgery had a lower average birth weight (847 versu s 997 g) and gestational age (26 versus 28 weeks; P < 0.05). Indometha cin treatment was successful in 27 infants. There were only three oper ative complications: a small pneumothorax, wound bleeding, and a small aortic tear. All recovered uneventfully and no deaths were attributab le to the surgical procedure itself. There was no difference in the in cidence of respiratory distress syndrome, duration of intubation, seps is, neonatal enterocolitis, renal dysfunction, bleeding disorders, or intraventricular hemorrhage among both groups. Surgical ligation of a PDA is associated with a high success rate, a low incidence of complic ations, and no additional morbidity than indomethacin alone. We propos e that surgical ligation should be regarded as a first line therapy fo r very small premature infants who are at higher risk of medical failu re.