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Background  The aim of this study was to determine the feasibility and outcomes of early surgical ligation in preterm neonates with hemodynamically significant patent ductus arteriosus (HSPDA) and to investigate predictors for surgical treatment after unsuccessful medical management.    Methods  Medical records from the neonatal intensive care unit of Hanyang University Seoul Hospital from January 2010 to December 2018 were retrospectively reviewed. 233 preterm neonates weighing less than 1500g with HSPDA were enrolled in our study. Of these preterm neonates, 134 underwent surgical ligation and were subdivided into the early ligation group ( n  = 49; within 10 days of age) and the late ligation group ( n  = 85; after 10 days of age).    Results  The mean gestational age and birth weight were significantly lower in the patent ductus arteriosus (PDA) ligation group than in the Non-ligation group ( p  <  0.001). PDA ductal diameter > 2.0 mm ( p  <  0.001), low Apgar score at 5 min ( p  = 0.033), and chorioamnionitis ( p  = 0.037) were the predictors for receiving surgical treatment for PDA. Early ligation was significantly associated with a low incidence of culture-proven sepsis ( p  = 0.004), mechanical ventilator time > 4 weeks ( p  = 0.007), necrotizing enterocolitis stage (NEC) ≥ III ( p  = 0.022), and intraventricular hemorrhage (IVH) grade ≥ III ( p  = 0.035).    Conclusions  Early surgical ligation minimizes the adverse effects of HSPDA in predicted preterm neonates who subsequently require surgical treatment for PDA. This result suggests that in preterm neonates weighing less than 1500g with HSPDA that is unresponsive to medical treatment, delayed ductal closure should be avoided to reduce severe NEC, severe IVH, culture-proven sepsis, and facilitate earlier endotracheal extubation.

Surgical ligation of patent ductus arteriosus in preterm neonates weighing less than 1500g: a 9-year single center experience