Surgical ligation, not transcatheter closure, associated with a higher severity of bronchopulmonary dysplasia in extremely preterm infant intervened for patent ductus arteriosus

Objective: : Patent ductus arteriosus (PDA) is a common complication among premature infants, and it may be responsible for prematurity-related complications, such as bronchopulmonary dysplasia (BPD). It is unclear whether different interventional methods contribute to the severity of BPD. To date, surgical ligation and the transcatheter approach have shown equal success in premature infants with hemodynamically significant PDA after medical treatment failure. Immediate improvement in the respiratory condition after transcatheter closure has been reported. However, the short-term pulmonary outcome has not been clarified yet. Methods: : This retrospective study investigated infants born with a body weight less than 1000 g and underwent either surgical ligation or transcatheter closure of PDA in a single tertiary institution. The infants were divided into groups according to the type of procedure (surgical ligation or transcatheter occlusion). The primary outcome was the severity of BPD at discharge or at post-menstrual age of 36 weeks. The outcome was analyzed with logistic regression. Results: : Forty-four patients met the inclusion criteria, and of these, 14 underwent transcatheter occlusion and 30 underwent surgical ligation. The overall birth body weight and gestational age ranges were not different. The univariate model revealed an association between the procedure type and BPD severity. The multivariate model confirmed associations of BPD severity with procedure type and severe respiratory distress syndrome requiring surfactant after adjusting for confounders. Conclusion: : Compared with the transcatheter approach, surgery for PDA in extremely preterm infants is associated with severe BPD at discharge. Further large-scale studies are needed to determine the exact mechanism.