Significance of Ligation of Patent Ductus Arteriosus in Premature Infant

Cho, Sung Rae; Lee, Chung Seok; Baek, Yong Woon

Abstract

BACKGROUND: Early surgical ligation of patent ductus arteriosus which has a significant hemodynamics and contraindications to the indomethacin therapy is a safe and effective therapeutic modality in premature infants. MATERIAL AND METHOD: From January 1995 to May 2000, 50 premature infants were diagnosed to have patent ductus arteriosus in Kosin University Hospital. There were 22 infants with asymptomatic PDA(Group I) and 28 infants with hemodynamically significant PDA which were treated with indomethacin(Group II, n=5) and surgical ligation(Group III, n=23). Group III had one or more contraindications to indomethacin therapy. Surgical ligation was done in the neonatal intensive care unit. This study is to compare the effects of surgical ligation and indomethacin therapy in premature infant with hemodynamically significant PDA. RESULT: Gestational age(week)and birth weight (g) were shorter and lesser in Group III(29.6 2.1, 1435 431.0) than in Group I(32.1 2.1, 1731 450.9), II(32 1.0, 1830 165.5) significantly(p<0.05), Age at the time of treatment (day) was not different in Group II(8.6 5.5) and III(7.3 4.4)(p<0.05), but body weight at the time of treatment(g) was lesser in Group III(1211 22.4) than Group II (1670 43.6) significantly(p<0.05). Survival rate(%) was higher in Group II(100) than Group III(73.9) significantly(p<0.05). The main causes of deaths were septicemia(5 cases), intracerebral hemorrhage(2), bronchopulmonary dysplasia(2), septic shock(1), and pneumothorax(1), which were not related to the operation.
CONCLUSION
Early surgical ligation of hemodynamically significant PDA was a very effective therapeutic modality, and was thought to be safely applicable to the premature infant with contraindication to the indomethacin therapy and the extremely low birth weight.