Is surgical ligation of a patent ductus arteriosus the preferred initial approach for the neonate with extremely low birth weight?

J Pediatr Surg. 1996 Aug;31(8):1134-7. doi: 10.1016/s0022-3468(96)90102-5.


The optimal approach to a patent ductus arteriosus (PDA) in an extremely low birth weight (ELBW) neonate, whether initial surgical ligation or a trial of indomethacin, has not been established. The authors reviewed the records of 82 ELBW premature infants who had surgical ligation of a PDA during a 2-year period. Thirty-one received indomethacin before ligation. Bronchopulmonary dysplasia (BPD) occurred in 33% of the infants. Predictors of BPD were prolonged positive pressure ventilation, severe intraventricular hemorrhage (IVH) and lower birth weight (BW). Seventy-seven percent of the infants survived. Predictors of mortality were severe IVH, lower BW, and the occurrence of necrotizing enterocolitis (NEC). The indomethacin-treated infants had a lower incidence of NEC and IVH. Overall, 16% of the patients had perioperative morbidity, and 10% of the patients died. The study shows that a trial of indomethacin therapy is not associated with increased complications in ELBW infants with PDA.

Publication types

  • Comparative Study

MeSH terms

  • Bronchopulmonary Dysplasia / etiology
  • Cerebral Hemorrhage / complications
  • Cerebral Ventricles
  • Chemotherapy, Adjuvant
  • Cyclooxygenase Inhibitors / therapeutic use*
  • Ductus Arteriosus, Patent / mortality
  • Ductus Arteriosus, Patent / surgery*
  • Humans
  • Indomethacin / therapeutic use*
  • Infant, Newborn
  • Infant, Very Low Birth Weight*
  • Multivariate Analysis
  • Premedication*
  • Retrospective Studies
  • Risk Factors


  • Cyclooxygenase Inhibitors
  • Indomethacin