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Updated: Oct 7, 2025
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
International Variation in the Management of Patent Ductus Arteriosus and Its Association with Infant Outcomes: A
Tetsuya Isayama1, Satoshi Kusuda2, Mark Adams3
1Division of Neonatology, Center for Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
Insights
Treating presymptomatic patent ductus arteriosus (PDA) in premature infants using routine echocardiography did not improve outcomes. Further research is needed to determine the efficacy and safety of early PDA treatment.
Area of Science:
- Neonatal Intensive Care
- Pediatric Cardiology
- Echocardiography
Background:
- Patent ductus arteriosus (PDA) is common in premature infants.
- Routine echocardiography is increasingly used to detect asymptomatic PDA.
- The benefit of treating asymptomatic PDA remains unclear.
Purpose of the Study:
- To evaluate if treating presymptomatic PDA, identified by routine echocardiography, improves outcomes in very preterm infants.
- To compare outcomes between infants who received treatment for presymptomatic PDA and those who did not.
Main Methods:
- Multicenter, retrospective cohort study of infants born <29 weeks gestation (2014-2016).
- Data collected via institutional questionnaires and patient records from 9 neonatal networks.
- Compared primary composite outcome (early death or severe intraventricular hemorrhage) and secondary outcomes.
Main Results:
- Treatment of presymptomatic PDA varied widely (7%-86%) across neonatal intensive care units (NICUs).
- No significant difference in early death or severe intraventricular hemorrhage between treated and untreated groups (17% vs 21%).
- Increased odds of retinopathy of prematurity treatment in the treated group (13% vs 7%).
Conclusions:
- Routine echocardiography-guided treatment of presymptomatic PDA in preterm infants showed no significant benefits.
- Current practice is widespread but lacks evidence of improved outcomes.
- Further randomized controlled trials are necessary to establish efficacy and safety of early PDA interventions.
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.
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