Neurodevelopmental outcomes following two different treatment approaches (early ligation and selective ligation) for patent ductus arteriosus

J Pediatr. 2012 Dec;161(6):1065-72. doi: 10.1016/j.jpeds.2012.05.062. Epub 2012 Jul 13.


Objective: To examine whether a change in the approach to managing persistent patent ductus arteriosus (PDA) from early ligation to selective ligation is associated with an increased risk of abnormal neurodevelopmental outcomes.

Study design: In 2005, we changed our PDA treatment protocol for infants born at ≤27 6/7 weeks' gestation from an early ligation approach, with prompt PDA ligation if the ductus failed to close after indomethacin therapy (period 1: January 1999 to December 2004), to a selective ligation approach, with PDA ligation performed only if specific criteria were met (period 2: January 2005 to May 2009). All infants in both periods received prophylactic indomethacin. Multivariate analysis was used to compare the odds of a composite abnormal neurodevelopmental outcome (Bayley Mental Developmental Index or Cognitive Score <70, cerebral palsy, blindness, and/or deafness) associated with each treatment approach at age 18-36 months (n = 224).

Results: During period 1, 23% of the infants in follow-up failed indomethacin treatment, and all underwent surgical ligation. During period 2, 30% of infants failed indomethacin, and 66% underwent ligation after meeting prespecified criteria. Infants treated with the selective ligation strategy demonstrated fewer abnormal outcomes than those treated with the early ligation approach (OR, 0.07; P = .046). Infants who underwent ligation before 10 days of age had an increased incidence of abnormal neurodevelopmental outcome. The significant difference in outcomes between the 2 PDA treatment strategies could be accounted for in part by the earlier age of ligation during period 1.

Conclusion: A selective ligation approach for PDAs that fail to close with indomethacin therapy is not associated with worse neurodevelopmental outcomes at age 18-36 months.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Blindness / diagnosis
  • Blindness / etiology*
  • Cardiovascular Agents / therapeutic use
  • Cerebral Palsy / diagnosis
  • Cerebral Palsy / etiology*
  • Child, Preschool
  • Combined Modality Therapy
  • Deafness / diagnosis
  • Deafness / etiology*
  • Developmental Disabilities / diagnosis
  • Developmental Disabilities / etiology*
  • Ductus Arteriosus, Patent / complications
  • Ductus Arteriosus, Patent / drug therapy
  • Ductus Arteriosus, Patent / surgery
  • Ductus Arteriosus, Patent / therapy*
  • Female
  • Follow-Up Studies
  • Humans
  • Indomethacin / therapeutic use
  • Infant
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases* / drug therapy
  • Infant, Premature, Diseases* / etiology
  • Infant, Premature, Diseases* / surgery
  • Infant, Premature, Diseases* / therapy
  • Ligation / methods
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Risk Factors
  • Treatment Outcome


  • Cardiovascular Agents
  • Indomethacin