Early Surgical Closure of Patent Ductus Arteriosus Improves Respiratory Outcome in Symptomatic Preterm Neonates

Abstract

Background: Surgical intervention to treat patent ductus arteriosus (PDA) is required when pharmacological treatment is contra-indicated or fails; however, the optimal time to perform surgery remains unclear. We evaluated the clinical outcome of surgical closure of PDA on symptomatic preterm neonates according to the timing of the operation.

Methods: We retrospectively evaluated 117 symptomatic preterm neonates who underwent surgical correction of PDA between April 2010 and December 2016.

Results: Morbidity and mortality rates were compared based on the timing of surgery. The early occlusion group was associated with significantly lower incidences of bronchopulmonary dysplasia (BPD) (odds ratio [OR] 0.298, p=0.011) and pneumonia (OR 0.874, p=0.023) than the late occlusion group. However, the former group had higher rates of mortality and intraventricular hemorrhage (IVH). Early occlusion was performed principally on neonates with primary occlusions. The morbidity rate of the secondary occlusion group did not vary by surgical timing.

Conclusions: Delayed PDA closure after medical treatment failure in neonates was associated with a higher incidence of BPD. Early primary PDA closure may improve the respiratory outcomes of preterm neonates, with acceptable safety.