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Does early-targeted risk-based management of a patent ductus arteriosus improve outcomes in preterm infants? Insights

Rachel Mullaly1,2, Aisling Smith2, Claire Murphy2

  • 1Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland rachelmullaly21@rcsi.ie.

BMJ Paediatrics Open
|July 16, 2025
PubMed

Insights

Early targeted management of patent ductus arteriosus (PDA) in preterm infants using the PDA Severity Score (PDAsc) improved respiratory outcomes in high-risk infants who responded to treatment. Further research is needed to confirm these findings.

Area of Science:

  • Neonatal Intensive Care
  • Pediatric Cardiology
  • Respiratory Medicine

Background:

  • Patent ductus arteriosus (PDA) management in preterm infants is critical.
  • The EL-Khuffash PDA Severity Score (PDAsc) aids in risk stratification.
  • Evaluating early-targeted PDA management strategies is essential.

Purpose of the Study:

  • To assess outcomes of an early-targeted PDA management strategy using PDAsc for risk stratification.
  • To compare outcomes between high- and low-risk preterm infants under early-targeted treatment versus a historical reference epoch.

Main Methods:

  • A single-centre, observational cohort study in a level III NICU.
  • Infants born <29 weeks gestation were stratified into high- and low-risk groups using PDAsc.
  • Outcomes (CLD, ventilation/oxygen days) were compared between early-targeted treatment and historical reference epochs.

Main Results:

  • High-risk infants with successful PDA closure in the early-targeted epoch had fewer ventilation/oxygen days and lower CLD incidence compared to the reference epoch.
  • High-risk infants who failed treatment in the early-targeted epoch had similar outcomes to the reference epoch.
  • Low-risk infants in both epochs showed comparable favorable outcomes.

Conclusions:

  • Early-targeted, risk-based PDA management may improve respiratory outcomes in responsive high-risk preterm infants.
  • The observational design limits causal inference; further RCTs are warranted.
  • Improved patient selection in future trials is recommended to clarify treatment-outcome relationships.
Abstract

Keywords:
Neonatology

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