All of these factors likely contribute to the disparate results of the studies. The database studies, with larger numbers of patients, were not able to demonstrate an advantage to primary surgery of the PDA compared with indomethacin treatment. There was insufficient information in these studies to review and make any comments on a relationship between the timing of PDA surgery and the development of NEC because the timing of the surgery was variable and often not clearly documented in the studies. Although the primary outcome of interest in the present review was NEC, a few studies suggested that primary surgical ligation may be associated with other adverse outcomes such as BPD/CLD and possibly neurodevelopmental impairment (NDI). The risk for potential NDI requires further study in this patient population.
Consensus on sciencePrimary surgery for PDA appears to be selectively chosen for infants of lower BW, younger GA and with contraindications to indomethacin therapy. Acknowledging this bias, the incidence of NEC is not lower in infants who undergo primary surgery for closure of the PDA compared with infants treated with indometha-cin or infants exposed to prophylactic indomethacin (LOE 2). It’s time for you to start saving some money: you just need to visit the pharmacy that offers finest quality >>> cipro antibiotic with delivery straight to your door and all the confidentiality guarantees you ever need.
RECOMMENDATION 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.