How to treat the PDA for the best outcome

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The options for many years for the treatment of the PDA in very low birth weight infants have been surgical ligation or indomethacin therapy. For some clinicians, the surgical option is preferable to the possible toxicities associated with indomethacin. Other clinicians do not have good access to PDA ligation or prefer the simplicity of indomethacin therapy. The recent availability of ibuprofen for ductal closure has not changed that equation. The TIPP trial demonstrated that there were not large differences in neurodevelopmental outcomes for infants receiving indomethacin relative to placebo. Depending on how they interpret the results, clinicians use the TIPP trial to justify or avoid the prophylactic use of indomethacin. The results of the new analysis of the TIPP trial by Kabra et al further complicate clinical decisions. Infants who received PDA ligation had less favorable neurodevelopmental outcomes, and BPD and ROP were more common after PDA ligation. These associations are consistent with other reports that anesthesia and surgery in the newborn period are associated with adverse long-term outcomes. The more we know about options to close the PDA, the less secure we are in how to best select the intervention.

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