Abstract / Summary
The association between surgical ligation of patent ductus arteriosus (PDA) and outcomes in extremely preterm infants remains uncertain because of treatment-selection and survival biases. Using data from the Taiwan Premature Infant Follow-up Network (1997–2017), we conducted a propensity score–matched cohort study of infants born at < 28 weeks’ gestation. Among 4071 infants with hemodynamically significant PDA, 1211 matched pairs were analyzed. Surgical ligation was associated with an increased risk of neurodevelopmental impairment (NDI) (adjusted risk ratio [ARR], 1.18; 95% CI 1.01–1.38) and lower mortality before discharge (ARR, 0.53; 95% CI 0.43–0.64), but not with the composite outcome of NDI or death (ARR, 0.96; 95% CI 0.86–1.08). Among infants surviving beyond 36 weeks’ postmenstrual age, associations with NDI (ARR, 1.15; 95% CI 0.97–1.36), mortality (ARR, 1.08; 95% CI 0.68–1.74), and the composite outcome (ARR, 1.14; 95% CI 0.97–1.34) were not statistically significant. Mediation analyses identified significant indirect associations through bronchopulmonary dysplasia and retinopathy of prematurity. These findings highlight the potential influence of treatment selection, survival-related bias, and postnatal morbidities on the observed associations between surgical ligation and subsequent outcomes and underscore the challenges of attributing adverse neurodevelopmental outcomes directly to surgical ligation.