Patent ductus arteriosus in preterm infants: benefits of early surgical closure.
BACKGROUND
Patent ductus arteriosus in preterm neonates leads to significant morbidity. Surgery is indicated when pharmacological treatment fails or is contraindicated, but the optimal timing remains unclear.


METHODS
We retrospectively studied all 41 preterm neonates with symptomatic ductus arteriosus who underwent ligation between 1988 and 2009. We compared early complications rates and late neurological outcomes of patients operated on before 21 days of age with these operated on later.


RESULTS
The median gestational age at birth was 26 weeks (range 23-31 weeks) and median weight at birth was 930 g (range 510-1500 g); 34 (82.9%) received pharmacological treatment before surgery. Fourteen (34.1%) patients underwent surgical closure before 21 days of age and 27 (65.9%) after 21 days. The 2 groups did not differ significantly in gestational age and weight at birth, but those operated on after 21 days received significantly more pharmacological treatment cycles. Patients in the early closure group had shorter intubation times: median 23 days (range 13-35 days) vs. 43 days (range 27-84 days; p < 0.001) and shorter neonatal intensive care unit stay: median 44 days (range 31-66 days) vs. 76 days (range 41-97 days; p < 0.001), with significantly lower rates of bronchopulmonary dysplasia, intraventricular hemorrhage, and acute renal failure, and significantly better neurological outcomes.


CONCLUSIONS
Performing early ligation of symptomatic ductus arteriosus after unsuccessful pharmacological therapy in preterm neonates might lower complication rates and improve neurological outcome. Prospective randomized studies are needed to determine the optimal treatment.
Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany.
Elizabeth
E
Fonseca
Stanimir G
SG
Georgiev
Matthias
M
Gorenflo
Tsvetomir S
TS
Loukanov
D001724:Birth Weight; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D004374:Ductus Arteriosus, Patent / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005865:Gestational Age; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007902:Length of Stay; D008026:Ligation; D008297:Male; D011183:Postoperative Complications / Q000628:therapy; D012189:Retrospective Studies; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
Patent ductus arteriousus; ligation; preterm neonate; treatment