International Variation in the Management of Patent Ductus Arteriosus and Its Association with Infant Outcomes: A Survey and Linked Cohort Study

International Network for Evaluating Outcomes of Neonates (iNeo) Investigators

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6 Scopus citations


Objective: To assess whether treating patients with a presymptomatic patent ductus arteriosus (PDA), based on early routine echocardiography, performed regardless of clinical signs, improved outcomes. Study design: This multicenter, survey-linked retrospective cohort study used an institutional-level questionnaire and individual patient-level data and included infants of <29 weeks of gestation born in 2014-2016 and admitted to tertiary neonatal intensive care units (NICUs) of 9 population-based national or regional neonatal networks. Infants in NICUs receiving treatment of presymptomatic PDA identified by routine echocardiography and those not were compared for the primary composite outcome (early death [≤7 days after birth] or severe intraventricular hemorrhage) and secondary outcomes (any in-hospital mortality and major morbidities). Results: The unit survey (response rates of 86%) revealed a wide variation among networks in the treatment of presymptomatic PDA (7%-86%). Among 246 NICUs with 17 936 infants (mean gestational age of 26 weeks), 126 NICUs (51%) with 7785 infants treated presymptomatic PDA. The primary outcome of early death or severe intraventricular hemorrhage was not significantly different between the NICUs treating presymptomatic PDA and those who did not (17% vs 21%; aOR 1.00, 95% CI 0.85-1.18). The NICUs treating presymptomatic PDA had greater odds of retinopathy of prematurity treatment (13% vs 7%; aOR 1.47, 95% CI 1.01-2.12); however, it was not significant in a sensitivity analysis excluding Japanese data. Conclusions: Treating presymptomatic PDA detected by routine echocardiography was commonplace but associated with no significant benefits. Well-designed trials are needed to assess the efficacy and safety of early targeted PDA treatment.

Original languageEnglish
Pages (from-to)24-29.e7
JournalJournal of Pediatrics
StatePublished - May 2022
Externally publishedYes


FundersFunder number
Instituto de Investigación Sanitaria Carlos III
Israel Center for Disease Control
Israel Neonatal Network
Sub-Directorate General for Research Assessment and Promotion
Swedish Neonatal Quality Register
Tuscany Neonatal Network
Ministerio de Ciencia, Innovación y UniversidadesFIS17/0131
Ministerio de Ciencia, Innovación y Universidades
Canadian Institutes of Health ResearchCTP 87518, APR-126340
Canadian Institutes of Health Research
Ontario Ministry of Health and Long-Term Care
Ministry of Health, Labour and Welfare
Karolinska Institutet2020-0443
Karolinska Institutet
Instituto de Salud Carlos III
Ministry of Health, British Columbia
European Regional Development FundRD16/0022
European Regional Development Fund
Regione Toscana
Sociedad Española de Neonatología
Terveyden ja hyvinvoinnin laitos


    • echocardiography
    • infants born preterm
    • patent ductus arteriosus
    • questionnaire survey


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