Could PDA ligation be a course of bronchopulmonary dysplasia?

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A patent ductus arteriosus (PDA) results in a left to right shunt in newborns. When the PDA is large enough, this can be associated with a variety of clinical complications, including congestive heart failure, necrotizing enterocolitis, and bronchopulmonary dysplasia (BPD). This has led neonatologists to search for different methods to close the PDA, including surgical ligation and pharmacologic closure with indomethacin.

In this issue of The Journal, Clyman et al report on a secondary analysis of a randomized clinical trial of ductus ligation to evaluate its effect on BPD. They also used a newer definition of BPD, which better characterizes the degree of respiratory burden. They found that although prophylactic ligation of the PDA eliminates the left to right shunt, it also increases the risk of BPD. The mechanisms underlying this increased risk are unclear. It could be due to the impact of a thoracic surgery or other factors. The authors emphasize that these results should not lead to abandoning surgical ligation as a treatment for a PDA, but they should lead to greater caution in considering the therapeutic alternatives when a hemodynamically important PDA is present.