Premature infant in incubator with ventilator, respiratory function graph overlay.

PDA Ligation in Preterm Infants: Who Benefits Most?

Jordan Keane in Health & Wellness December 2025 • 4 min read.

"Discover how high-frequency ventilation can predict respiratory improvement after PDA ligation, and what this means for babies with severe lung disease."

Patent ductus arteriosus (PDA), a common condition in preterm infants, involves continuous blood shunting that can overwhelm a newborn's delicate respiratory system. When medications fail to close the PDA, surgical ligation becomes a necessary intervention.

However, the decision to ligate is not without controversy. Concerns about potential harm have led to a more selective approach, reserving ligation for extreme cases. Clinicians often weigh the degree of respiratory support an infant needs when considering this procedure.

Now, a new study published in The Journal of Pediatrics sheds light on which infants are most likely to benefit from PDA ligation in terms of respiratory improvement. The research identifies a key predictor and offers insights into optimizing treatment strategies for these vulnerable patients.

High-Frequency Ventilation: A Key Predictor

Premature infant in incubator with ventilator, respiratory function graph overlay.

Researchers conducted a two-phase study involving preterm infants with a birth weight of less than 1500 grams. The first phase was a retrospective analysis of infants undergoing PDA ligation. The second phase compared these infants to a matched control group, balancing factors like gestational age and pre-ligation respiratory condition.

Respiratory improvement was defined as extubation, a downgrade in ventilation mode, or a significant reduction in either mean airway pressure (MAP) or fraction of inspired oxygen (FiO2).

The study revealed that infants on high-frequency ventilation (HFV) were significantly more likely to show respiratory improvement after ligation. Specifically, 42% of infants showed respiratory improvement at 7 days, with those on HFV having a much higher chance of improvement.
The adjusted odds ratio (aOR) for respiratory improvement in infants on HFV was 5.03 (95% CI [1.14-22.18]).

However, among infants on conventional ventilation, the ligation group experienced higher respiratory support in the immediate post-ligation period without corresponding respiratory benefits at 7 days. This suggests that while HFV can indicate potential benefit from ligation, conventional ventilation may not yield the same positive outcomes.

Clinical Implications and Future Directions

These findings suggest that HFV may serve as a marker for identifying infants who could benefit most from PDA ligation. Because HFV is often used as a rescue mode for infants with severe lung disease, the study indicates that those with the most compromised respiratory systems may experience the greatest short-term benefits from ligation.

It's important to note that while ligation may prevent further respiratory deterioration in infants on HFV, it doesn't necessarily guarantee respiratory improvement for all infants, especially those on conventional ventilation. Clinicians should carefully weigh the potential risks and benefits of PDA ligation, considering individual respiratory status and ventilation mode.

Further research is needed to understand the long-term respiratory outcomes and to identify additional predictors of success for PDA ligation in preterm infants. These findings may lead to more targeted and effective treatment strategies, ultimately improving the outcomes for these vulnerable newborns.

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This article is based on research published under:

DOI-LINK: 10.1016/j.jpeds.2018.09.061, Alternate LINK

Title: Predictors Of Respiratory Improvement 1 Week After Ligation Of Patent Ductus Arteriosus In Preterm Infants

Subject: Pediatrics, Perinatology and Child Health

Journal: The Journal of Pediatrics

Publisher: Elsevier BV

Authors: Kai-Hsiang Hsu, Pierre Wong, S. Ram Kumar, Julie Evans, Shahab Noori

Published: 2019-02-01

Everything You Need To Know

What is patent ductus arteriosus (PDA), and why is its ligation in preterm infants a controversial decision?

Patent ductus arteriosus or PDA is a condition common in preterm infants where continuous blood shunting occurs, potentially overwhelming the newborn's respiratory system. When medication is ineffective, surgical ligation is considered. The controversy arises due to concerns about potential harm, leading to a selective approach where ligation is reserved for extreme cases after evaluating the degree of respiratory support the infant needs.

How does high-frequency ventilation (HFV) serve as a predictor for respiratory improvement after PDA ligation?

High-frequency ventilation (HFV) can be a key predictor. Research indicates that preterm infants on HFV are more likely to show respiratory improvement after undergoing patent ductus arteriosus (PDA) ligation. Specifically, a significant percentage of infants on HFV exhibited respiratory improvement seven days post-ligation, suggesting HFV status can identify those who will likely benefit from the procedure.

In the context of this study, how was 'respiratory improvement' specifically defined after PDA ligation?

Respiratory improvement was defined by specific measurable criteria: extubation, a downgrade in ventilation mode, or a noteworthy reduction in either mean airway pressure (MAP) or fraction of inspired oxygen (FiO2). This establishes objective benchmarks for assessing the effectiveness of patent ductus arteriosus ligation, ensuring consistent evaluation across different infants and clinical settings.

What were the main findings regarding respiratory outcomes in infants on high-frequency ventilation (HFV) versus conventional ventilation after PDA ligation?

The study revealed that infants on high-frequency ventilation (HFV) showed significant respiratory improvement, while those on conventional ventilation experienced increased respiratory support without the same respiratory benefits seven days post-ligation. The adjusted odds ratio (aOR) for respiratory improvement in infants on HFV was 5.03 (95% CI [1.14-22.18]). This suggests that while HFV indicates potential benefit from ligation, conventional ventilation may not yield the same positive outcomes.

Based on the research, what are the potential clinical implications of using high-frequency ventilation (HFV) as an indicator for PDA ligation benefits in preterm infants?

These results suggest that high-frequency ventilation (HFV) status could serve as a marker for identifying infants most likely to benefit from patent ductus arteriosus (PDA) ligation, especially given that HFV is often used for infants with severe lung disease. This implies that infants with the most compromised respiratory systems may experience the greatest short-term benefits from ligation. However, further research is needed to determine long-term outcomes and optimal management strategies.