Related Experiment Video
Updated: May 7, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Procedural closure of the patent ductus arteriosus in preterm infants: a clinical practice guideline
Souvik Mitra1, Adrianne R Bischoff2, Shyam Sathanandam3
1Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, Canada.
Insights
Procedural closure for patent ductus arteriosus (PDA) in preterm infants is recommended under specific conditions. Transcatheter closure may be preferred over surgical ligation when expertise is available.
Area of Science:
- Neonatal Cardiology
- Pediatric Surgery
- Clinical Practice Guidelines
Background:
- Transcatheter closure of patent ductus arteriosus (PDA) is increasingly used for preterm infants.
- Guidelines are needed for procedural PDA closure in this population.
Purpose of the Study:
- To establish clinical practice guideline recommendations for procedural PDA closure in preterm infants.
Main Methods:
- Utilized the GRADE Evidence-to-Decision framework.
- Conducted an e-Delphi survey with 45 experts.
- Accepted recommendations with ≥75% consensus.
Main Results:
- Procedural closure considered for extremely preterm infants (<28 weeks GA) on mechanical ventilation >10 days with hemodynamically significant PDA.
- Consideration is advised at centers with high rates of death or bronchopulmonary dysplasia.
- Transcatheter closure may be preferred over surgical ligation if expertise and patient suitability permit.
Conclusions:
- Conditional recommendation for procedural PDA closure in select extremely preterm infants.
- Conditional recommendation favoring transcatheter closure when feasible and appropriate.
- Emphasizes careful patient selection and institutional expertise for PDA management.
Importance:
Transcatheter closure of the patent ductus arteriosus (PDA) is being increasingly adopted as an alternative to surgical PDA closure in preterm infants.
Objective:
To develop rigorous clinical practice guideline recommendations on procedural PDA closure in preterm infants.
Methods:
The principles of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Evidence-to-Decision (EtD) framework were used to develop the guideline recommendations. An e-Delphi survey of 45 experts was conducted and recommendations that reached ≥75% agreement were accepted as consensus.
Main Recommendations:
Procedural PDA closure may be considered in extremely preterm infants (<28 weeks gestational age) requiring invasive mechanical ventilation >10 postnatal days and confirmed to have a large hemodynamically significant PDA, at centers with high local rates of death and/or bronchopulmonary dysplasia (conditional recommendation). If sufficient institutional expertise is available and patient characteristics are suitable, transcatheter PDA closure may be considered as the preferred approach over PDA ligation (conditional recommendation).
