A recent international survey has revealed a significant lack of consensus among neonatologists regarding the diagnosis and management of patent ductus arteriosus (PDA) in premature infants. This variability exists despite PDA being a common issue in preterm babies, where its incidence is inversely related to gestational age. While early pharmacological treatment to close PDA is available, the optimal approach remains debated due to the uncertain long-term benefits. This survey aimed to investigate the current landscape of PDA management, focusing on the availability of guidelines, diagnostic criteria, and treatment strategies, and to explore the extent of clinical equipoise among practitioners.
The internet-based survey, conducted between September 2019 and March 2020, targeted professionals involved in PDA management. It collected data on baseline characteristics, guideline availability, screening strategies, diagnostic criteria for hemodynamic significance, treatment approaches, and efficacy metrics. Crucially, it also assessed clinical equipoise using ten statements on a Likert scale. Out of 144 surveys distributed, 71 were analyzed, with a strong completion rate of 79%. The respondents were primarily neonatologists working in level III neonatal intensive care units, with 51% having previously co-authored publications on PDA.
The survey results highlighted a striking absence of national guidelines for PDA management. Furthermore, it exposed a heterogeneous approach to screening practices and a marked variability in the diagnostic criteria used to determine hemodynamic significance. This lack of uniformity extended to treatment strategies and the methods employed to evaluate treatment effectiveness. Interestingly, no significant differences in practice were observed between respondents who had and had not co-authored PDA publications, except that those who screened for PDA more frequently were more inclined towards early and aggressive treatment.
Perhaps most revealing was the wide variation in scores related to clinical equipoise statements. This underscores the lack of consensus about the correct diagnosis and optimal treatment pathways for PDA. The existing evidence base appears insufficient to guide the harmonization of treatment strategies into consistent (inter)national guidelines.
In conclusion, this survey emphasizes the considerable heterogeneity and the absence of clear guidelines in current PDA management practices. The findings suggest that the lack of robust evidence contributes to the ongoing debate and the lack of consensus about the correct diagnosis and treatment of PDA in preterm infants. This situation highlights the urgent need for further research to establish definitive guidelines and standardize care for this vulnerable population.
What is Known:
- Patent ductus arteriosus (PDA) incidence is inversely related to gestational age.
- Optimal PDA treatment is debated despite effective pharmacological closure due to uncertain outcome benefits.
What is New:
- Significant heterogeneity and contradiction exist in diagnostic and treatment strategies for PDA due to the absence of (inter)national guidelines.
- PDA screening strategies, but not PDA publication status, correlate with differences in treatment approaches and responses regarding clinical equipoise.
