Does primary surgical closure of the patent ductus arteriosus in infants <1500 g or ≤32 weeks' gestation reduce the incidence of necrotizing enterocolitis?

Abstract

Background: The hemodynamic perturbation related to patent ductus arteriosus (PDA) is associated with a higher risk of necrotizing enterocolitis (NEC). Objective: To determine whether primary surgical closure, as compared with treatment with indomethacin or exposure to prophylactic indomethacin, reduces the incidence of NEC in preterm infants <1500 g and/or ≤32 weeks' gestation with clinically and echocardiogram-identified PDA. Methods: The literature was reviewed using the methodology for systematic reviews for the Consensus of Science adapted from the American Heart Association's International Liaison Committee on Resuscitation. Results: Ten studies were reviewed. The incidence of NEC was not lower in infants who underwent primary surgery for closure of the PDA compared with infants treated with indomethacin or infants exposed to prophylactic indomethacin (level of evidence 2). Conclusion: Primary surgical closure of the PDA cannot be recommended as an intervention to decrease the incidence of NEC in infants <1500 g and/or ≤32 weeks' gestation. ©2012 Pulsus Group Inc. All rights reserved.