Prophylactic indomethacin therapy has been recommended in the management of PDA in ELBW infants. Exogenous surfactant therapy has been reported to alter the presentation and the incidence of PDA in premature infants. Prophylactic surfactant therapy is associated with a higher incidence of clinically symptomatic PDA. We prospectively evaluated ductal patency and degree of left to right ductal shunt by serial echocardiograms in 290 ELBW inborn infants admitted to our NICU. Overall incidence of PDA in ELBW infants was 68%. Indocin was given in 157/198 {79%} infants. PDA ligation was performed in 74 / 198 {37%} infants. Sixty six percent of {193/290} infants received early rescue surfactant therapy for respiratory distress syndrome.Table

Table 1
Full size table

Overall incidence of echocardiographically documented PDA in ELBW infants was unaffected by rescue surfactant therapy in ELBW infants. However, the incidence of hemodynamically significant PDA requiring indomethacin treatment was significantly higher p <0.001 among surfactant treated infants. PDA ligation was done more often in surfactant treated infants p <0.05. Prophylactic ductal closure with indomethacin or by surgical ligation has not been shown to decrease long-term pulmonary morbidity in ELBW infants. Since indomethacin therapy has been associated with significant morbidity, risk / benefit ratio must be assessed critically prior to exposing a large group of non-surfactant treated ELBW infants to prophylactic indomethacin therapy.

Funded by the Hastings Foundation.