Variations in diagnosis and management of hemodynamically significant patent ductus arteriosus across neonatal intensive care units in the Children’s Hospitals Neonatal Consortium

Abstract

Abstract Objective Collate patent ductus arteriosus (PDA) guidelines among Children’s Hospitals Neonatal Consortium (CHNC) centers and identify variations in the diagnosis and management of hemodynamically significant PDA (hsPDA). Study Design: A descriptive survey requesting written PDA guidelines was sent to CHNC representatives from November 2023 to February 2024. Our study methods were performed in accordance with the survey guidelines and regulations of the CHNC. No PHI identifiers or institutional data were utilized for performing this study. Results Of 44 centers, 38 (86%) responded; 25 (67%) provided written guidelines. Clinical signs of PDA were included in 18 (72%) guidelines, and 21 (84%) specified echocardiographic criteria for hsPDA. Ibuprofen was the most common first-line therapy, followed by acetaminophen and indomethacin. Most centers outlined a stepwise management approach including fluid restriction, diuretics, pharmacotherapy, and transcatheter closure. Surgical ligation was less frequently recommended. Conclusions A majority of CHNC centers maintain written hsPDA guidelines incorporating clinical and echocardiographic criteria. Management emphasizes a stepwise approach from expectant to active management with pharmacotherapy and increasing adoption of transcatheter closure, highlighting evolving practice patterns in neonatal PDA care.