Which treatment is most effective for patent ductus arteriosus (PDA)?

Updated: Nov 20, 2018
  • Author: Luke K Kim, MD; Chief Editor: Stuart Berger, MD  more...
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Answer

Although indomethacin therapy is preferred in most intensive care nurseries (NICUs) as the first-line approach to effect patent ductus arteriosus (PDA) closure, the benefits of this approach over surgical ligation are not obvious. In most studies that attempt to evaluate differences in the outcomes for indomethacin therapy and surgical closure, results are similar. A Cochrane review failed to demonstrate that the net harm-to-benefit ratio favored either surgical ligation or medical therapy. [8] Observational studies suggest that surgical ligation is associated with higher likelihood of chronic lung disease, retinopathy of prematurity, and neurosensory impairment. These data may be questionable, because surgical ligation is not available in every nursery, whereas medical therapy is widely available.

A meta-analysis by Weisz et al did suggest that compared with pharmacologic treatment, surgical ligation for patent ductus arteriosus in preterm infants is associated with a reduced mortality rate but also with an increased morbidity risk. Again, however, the results were uncertain. In the report, derived from 39 cohort studies and 1 randomized, controlled trial, the investigators found that in infants born at less than 32 weeks’ gestation, the mortality rate in those who underwent ligation for patent ductus arteriosus was about half that of infants who were treated with medication for the condition. [26, 27]

In contrast, the incidence of neurodevelopmental impairment (NDI), chronic lung disease, and severe retinopathy of prematurity was increased in infants who underwent ligation, with adjusted odds ratios of 1.54, 2.51, and 2.23, respectively. However, the investigators were unable to draw conclusions from the meta-analysis because almost none of the cohort studies took into account survival bias or considered important confounders, such as ventilator dependence, sepsis, or intraventricular hemorrhage, that may have been present prior to ligation. [26, 27]


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