Surgical closure of patent ductus arteriosus outside the operating theater

The widespread availability of newborn centers and competent management of respiratory problems in the newborn have allowed survival of many infants with patent ductus arteriosus (PDA) who previously would have died. Most deaths after surgical correction of PDA in the newborn have been due to problems in management of ventilation and nursing care. Since most patients are intubated and on respirators prior to election of operative closure, we decided to close the ductus in the newborn center, without moving the patient or disturbing the equipment. The same nurses and pediatric fellows would manage the infant after surgery. The first 9 consecutive premature infants with near-fatal respiratory problems associated with patent ductus arteriosus and operated upon in the newborn center all survived, improved, and were discharged home. There were no infections or other major surgical complications. We conclude that, in properly selected patients, surgical closure of the patent ductus arteriosus is best done in the newborn center under local anesthesia.