Patent ductus arteriosus in very low birthweight infants: complications ofpharmacological and surgical treatment

Aims: To evaluate complications of surgical and pharmacological treatment o f symptomatic patent ductus arteriosus (PDA) in very low birthweight (VLBW) infants. Patients and methods: Of 931 VLBW infants consecutively admitted 1987-1998, a significant PDA prompted first-choice treatment by indomethacin in 101 i nfants, and surgery in 55 infants. PDA closed or became asymptomatic after indomethacin in 64 patients (63%), while 34 went on to surgery. PDA closure was achieved in all 61 infants after ligation and in 26 of 28 infants afte r clipping. Results: Transient renal impairment after indomethacin treatment was record ed in 40 of 101 infants (40%), compared to renal impairment in 9 of 55 infa nts (16%) undergoing surgery without prior indomethacin. No differences in necrotizing enterocolitis and intracranial hemorrhage rates were seen. Air leak occurred in 6 of 89 infants after surgery, two of which had fatal tens ion pneumothorax. Intraoperative hemorrhage requiring emergency transfusion occurred in 2 infants, wound infection occurred in 2 infants and phrenic p alsy in one infant. Based on an intention-to-treat analysis, the overall fa tality rates were 16 of 101 (16%) for indomethacin and 14 of 55 (25%) for s urgery. Conclusions: Despite the short-comings inherent to retrospective analyses, we propose that surgery should be reserved for infants not responding to ph armacological PDA closure.