Short-term outcomes of patent ductus arteriosus ligation in preterm neonates: reason for concern?

We evaluated outcomes of preterm infants following surgical ligation of patent ductus arteriosus (PDA). We performed a retrospective chart review. Our cohort (N = 82) had a median (range) gestational age of 25.5 (23 to 28) weeks and birth weight of 765 (484 to 1150) g. Ligation was the initial intervention in the primary group (N = 28) and was performed after failed medical therapy in the secondary group (N = 54). At 48 hours following ligation, an increase in fraction of inspired oxygen (FiO(2)) and ventilatory and pressor support were observed in 49 (60%), 35 (43%), and 15 (18%) infants, respectively. The median (range) duration to return to preoperative FiO(2) was 3 (1 to 30) days and extubation was 16 (1 to 98) days. Rates of bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage, necrotizing enterocolitis, and retinopathy were 42.7%, 32.9%, 19.6%, and 11%, respectively. Outcomes did not differ between primary and secondary ligation groups, nor between early (4 weeks old, N = 30). A lower gestation was significantly associated with postoperative deterioration and BPD. Preterm infants undergoing PDA ligation often experience a postoperative deterioration and have an extremely high incidence of comorbidities. Whether the ductus itself or the "therapeutic" ligation is causally linked to these adverse outcomes remains to be determined.