Related Experiment Video

Updated: Jan 23, 2026

A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting
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Patent ductus arteriosus: emerging trial evidence firmly supports conservative management in preterm infants

Nehal A Parikh1,2,3, Sanjana Velu1,2

  • 1The Perinatal Institute.

Current Opinion in Pediatrics
|January 22, 2026
PubMed

Insights

Conservative management of patent ductus arteriosus (PDA) is recommended for very preterm infants. Current evidence shows medical therapies and transcatheter closure do not improve outcomes and may increase risks like bronchopulmonary dysplasia or death.

Area of Science:

  • Neonatalogy
  • Pediatric Cardiology
  • Clinical Trials Research

Background:

  • Patent ductus arteriosus (PDA) is common in very preterm infants (<32 weeks' gestation).
  • PDA closure therapies are frequently employed, but evidence on their benefits and risks is evolving.

Purpose of the Study:

  • To review recent randomized clinical trials (RCTs) and meta-analyses on PDA closure therapies versus conservative management.
  • To evaluate the impact on key outcomes like bronchopulmonary dysplasia (BPD) or death in very preterm infants.

Main Methods:

  • Systematic review of RCTs and meta-analyses published in the last decade.
  • Analysis of outcomes including BPD/death at 36 weeks postmenstrual age and mortality.

Main Results:

  • Ten RCTs of medical PDA therapies showed no reduction in moderate-severe BPD/death compared to placebo.
  • Meta-analysis of these RCTs indicated an increased risk of BPD/death (RR: 1.10) and mortality (RR: 1.25).
  • Recent meta-analyses confirm increased mortality with early medical PDA treatment; transcatheter closure lacks safety/efficacy trials.

Conclusions:

  • Conservative PDA management is the evidence-based approach.
  • Clinical experimentation with PDA closure is no longer justifiable.
  • Expectant management should be the standard of care to uphold the 'first, do no harm' principle.
Abstract

Keywords:
bronchopulmonary dysplasiameta-analysismortalitypatent ductus arteriosuspreterm infants

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