Risk Factors and Neonatal Outcomes of Patent Ductus Arteriosus Ligation in Preterm Infants in a Single Center over 6 Years

Objective: To determine the effects of patent ductus arteriosus (PDA) ligation, clinical characteristics of infants who need surgical ligation of PDA and risk factors of PDA ligation were evaluated. Methods: Preterm infants with gestational age (GA) <30 weeks presenting with hemodynamically significant ductus arteriosus (HSDA) were enrolled. HSDA was closed with ibuprofen (medical group, n=55) or surgical ligation (surgical group, n=57). Results: GA and birth weight were smaller in the surgical group (27.8±1.4 weeks in the medical group vs. 26.1±1.6 weeks in the surgical group, P<0.001; 959±241 g in the medical group vs. 815±193 g in the surgical group, P=0.001, respectively). There were no significant differences in gender, Apgar scores, antenatal steroids therapy, maternal gestational diabetes mellitus, pregnancy-induced hypertension, or chorioamnionitis between the two groups. In the surgical group, total duration of mechanical ventilation and duration of invasive ventilation were longer, although postnatal day of ductal closure was not delayed. Moderate to severe bronchopulmonary dysplasia, high-grade intraventricular hemorrhage (≥grade 3), retinopathy of prematurity (≥stage 2), necrotizing enterocolitis (≥stage 2), and mortality rate were also similar between the two groups. Low GA was a significant risk factor associated with surgical ligation of PDA (adjusted odds ratio 0.493, 95% confidence interval 0.366-0.666; P<0.001). Conclusion: Although surgical ligation of PDA is inevitable in certain cases with large shunt and severe respiratory failure, clinicians should weigh the benefit of ductal closure and complications associated with surgery.