Recent emphasis on the use of routine prophylactic indomethacin in preterm neonates is not without risk. Studies have shown a risk for increased ileal perforation (Am J Perinatol 11:295-6, 1994) as well as other complications associated with indomethacin administration (Am J Physiol 269:H1450-9, 1995). There is a known association with delayed closure of a PDA (as exemplified by prolonged and repeated courses of indomethacin) and increased risk of chronic lung disease. To avoid administration of indomethacin in over 50% of “at risk” neonates whose PDA's would close spontaneously (J Pediatr 128:631-7, 1996), early surgical ligation of a symptomatic PDA(6.90±0.24 days) was performed in preterm infants under 1,250 grams without indomethacin prophylaxis or treatment. Analysis of the 21 patients who had ligation performed are compared to the 20 other neonates in the same weight range whose PDA's closed without therapy during the study period.

There was no increase in morbidity or mortality noted as a result of the ligation procedure. Neonates requiring PDA ligation were initially more compromised; however, adjusted for gestational age and weight, hospital stay in the ligation group approached that of the group without symptomatic PDA. Survival by birthweight and gestational age in both groups exceeded published rates and was not statistically different between groups. We propose early ligation of a symptomatic PDA as the preferred therapy in extremely low birthweight premature infants. Table

Table 1 No caption available.