Timing of surgical ligation and morbidities in very low birth weight infants

The present study examined whether early patent ductus arteriosus (PDA) surgical ligation at <= 2 weeks of life was associated with increased morbidities and mortality in very low birth weight infants (VLBWIs) who were diagnosed with hemodynamically significant (hs) PDA. Between December 2013 and December 2015, a total of 407 VLBWIs were admitted, of whom 145 (35.6%) infants were diagnosed with an hs PDA. The clinical data for these infants were retrospectively collected for analysis. Among the 145 VLBWIs with an hs PDA, 58 (40%) infants had surgical ligation for PDA; of these, 29 (50%) infants had early ligation (EL; ligation at <= 2 weeks of life) and 29 (50%) infants had late ligation (LL; ligation at >= 2 weeks of life). The mean gestational age and birth weight were significantly lower in the PDA-ligated group compared with the nonligated group. In addition, pulmonary hypertension at <= 1 week of life and neonatal seizures were significantly more prevalent in the ligated group (P<0.05). Increased rate of ROP laser treatment, bronchopulmonary dysplasia, longer hospital stays, and longer duration of mechanical ventilation were found in ligated group (P< 0.05). However, the morbidities and mortality did not differ significantly between the EL and LL groups. Pulmonary hypertension at <= 1 week of life was significantly associated with LL (P=0.019), which was consistently a risk factor for hs PDA ligation in our multivariable logistic regression analysis. EL was not significantly associated with increased hospital morbidities and mortality in VLBWIs with hs PDA. Pulmonary hypertension at <= 1 week of life can be a risk factor for the need for surgical ligation of hs PDA.