This study aims to determine whether early closure (within 7 d) of significant patent ductus arteriosus (PDA) with indomethacin or ligation reduces neonatal morbidity when compared with delayed closure (after 7 d).

Fifty-eight extremely-low-birth-weight infants admitted to the NICU of Seoul National University Hospital from April 2005 to May 2007 with PDA were studied retrospectively.

The mean gestational age (GA) was 26±2 weeks (range, 23-32 wk), and the birth weight was 782±146 g (range, 430-990 g). The delayed closure group was associated with early GA (25.7±1.7 wk vs. 27.1±2.0 wk, P =0.013), in vitro fertilization (IVF) (55% vs 24%, P =0.017), and the absence of preeclampsia (5% vs. 34%, P =0.013). There was no difference in ductal size between the early closure and delayed closure groups. The incidence of bronchopulmonary dysplasia (95% vs 65%, P =0.012) and intraventricular hemorrhage (70% vs. 39%, P =0.027) increased in the delayed closure group. Using regression analysis adjusted for gestational age, delayed closure correlated positively with the duration of ventilator support ( P =0.008), hospitalization ( P =0.020), time to full enteral feeding ( P <0.001), and total parenteral nutrition ( P =0.010).

Delayed closure of the hemodynamically significant patent ductus arteriosus in extremely-low-birth-weight infants is significantly related to the development of various morbidities. Thus, early closure of PDA is needed within the first week of life.