Is there an optimal timing for surgical ligation of patent ductus arteriosus in preterm infants?

  • Vladimiro Vida, Department of Pediatric and Congenital Cardiac Surgery, University of Padua, Italy
  • Paola Lago, Department of Pediatrics, University of Padua, Italy
  • Sabrina Salvadori, Department of Pediatrics, University of Padua, Italy
  • Dr Giovanna Boccuzzo, Department of Statistics, University of Padua, Italy
  • Massimo Padalino, Department of Pediatric and Congenital Cardiac Surgery, University of Padua, Italy
  • Ornella Milanesi, Department of Pediatrics, University of Padua, Italy
  • Simone Speggiorin, Department of Pediatric and Congenital Cardiac Surgery, University of Padua, Italy
  • Giovanni Stellin, Department of Pediatric and Congenital Cardiac Surgery, University of Padua, Italy

    • Objective: We sought to define the variables associated with hospital outcome in preterm infants with patent ductus arteriosus (PDA), and also to identify the optimal timing for PDA closure, in order to improve hospital outcome.
    Patients and Methods: From January 2001 to June 2007, all premature babies with PDA who were ≤ 32 weeks of gestational age who received primary medical treatment with ibuprofen, were included. Number of Ibuprofen’s cycles, gestational age, body weight and presence of symptomatic hypotension requiring vasoactive/inotropic drugs were related to hospital outcome, including hospital mortality, presence of necrotizing enterocolitis, acute renal failure, intra-ventricular haemorrhage, retinopathy and bronco-pulmonary dysplasia at 36th week. A logistic regression model was used to analyze the data.
    Results: There were 201 consecutive patients. Medical treatment was effective in 149 patients (75%). Fifty-two patients (25%) required surgical ligation after failed medical treatment; they had lower gestational age (25±2.1 vs 27±2.3 weeks, p<0.0001), lower body weight (745±186 vs 892±257 grams, p=0.0002) and higher incidence of symptomatic hypotension (38/52, 73% vs 56/149, 38%, p<0.0001) than patients who respond to ibuprofen. The prolonged medical treatment (>2 cycles of Ibuprofen) was significantly associated with an increased risk for bronco-pulmonary dysplasia (OR=2.81, p=0.03) and acute renal failure (OR=3.81, p=0.09).
    Conclusions: The prolonged patency of the ductus arteriosus in preterm infants is related to an increased morbidity. Surgical ligation of PDA is a safe and effective treatment and should be done soon after 2 complete cycles of ibuprofen, especially in selected patients, to improve clinical outcome.