Analysis of outcome in 298 extremely low-birth-weight infants with patent ductus arteriosus

Purpose: Indomethacin is accepted therapy for patent ductus arteriosus (PDA) in ELBW infants (<1000 g). We hypothesize that surgical ligation may provide comparatively superior outcomes in select ELBW infants. Methods: Predischarge outcomes of 298 ELBW infants with echocardiography-proven PDA were retrospectively compared by treatment provided: no treatment (group 1, n = 54), indomethacin (group 2, n = 140), ligation (group 3, n = 46), and ligation after indomethacin failure (group 4, n = 58). X 2 and Wilcoxon rank sum tests were used to test for significance. Institutional review board approval was obtained (IRB/05-00395). Results: Group 3 had significantly lower gestational age (P <.00 1), birth weight (P =.006), and 5-minute Apgar scores (P =.03) compared with group 2. Group 3 and group I had a higher rate of pretreatment intraventricular hemorrhage (IVH) compared with group 2 (P <.001). By contrast, posttreatment complications including acute renal failure, necrotizing enterocolitis, thrombocytopenia, and IVH occurred more frequently in groups 2 (P =.004) and 4 (P =.001) compared with group 3. Survival was 57.7% in group 1 compared with groups 2, 3, and 4 (82.4%, 86.0%, and 92.7% respectively; P =.001). Preoperative conditions associated with nonsurvival include gestational age (P =.009), birth weight (P =.002), maternal preeclampsia (P =.015), 5-minute Apgar score (P =.013), and sepsis (P.018). Posttreatment complications associated with nonsurvival include acute renal failure (P=.002), thrombocytopenia (P=.002), and necrotizing enterocolitis (P=.034). Survival was not influenced by any congenital comorbidity, pre- or posttreatment IVH, diameter of the PDA, or recurrence of the PDA after indomethacin therapy. Conclusions: (1) Patent ductus arteriosis requires treatment in ELBW infants to maximize survival. (2) Indomethacin and surgical ligation permit equivalent survival in low-risk ELBW infants, but indomethacin results in a high failure and complication rate requiring operative salvage in a number of patients. (3) Surgical ligation permits survival of high-risk ELBW infants with a low complication rate and is preferable to indomethacin in ELBW infants with the above risk factors. (c) 2009 Elsevier Inc. All rights reserved.