The Timing of Surgical Ligation for Patent Ductus Arteriosus Is Associated with Neonatal Morbidity in Extremely Preterm Infants Born at 23-25 Weeks of Gestation

The purpose of this study was to evaluate prognostic factors associated with surgicalligation for patent ductus arteriosus (PDA) in extremely preterm infants born at the limitsof viability. Ninety infants who were born at 23-25 weeks of gestation and who receivedsurgical ligation were included and their cases were retrospectively reviewed. Infants wereclassified into two different groups: survivors with no major morbidity (N), and nonsurvivorsor survivors with any major morbidity (M). Clinical characteristics were comparedbetween the groups. Possible prognostic factors were derived from this comparison andfurther tested by logistic regression analysis. The mean gestational age and the mean birthweight of M were significantly lower than those of N. Notably, the mean postnatal age attime of ligation in N was significantly later than that of the other group (17 ± 12 vs11 ± 8 days in N and M, respectively). An adjusted analysis showed that delayed ligation( > 2 weeks) was uniquely associated with a significantly decreased risk for mortality orcomposite morbidity after surgical ligation (OR, 0.105; 95% CI, 0.012-0.928). Inconclusion, delayed surgical ligation for PDA ( > 2 weeks) is associated with decreasedmortality or morbidities in extremely preterm infants born at 23-25 weeks of gestation.