Abstract Body (Do not enter title and authors here): Background
In recent years, there has been a rise in the adoption of conservative approaches to managing patent ductus arteriosus (PDA) in preterm infants. Systematic appraisal of the clinical evidence supporting this approach is essential for guiding recommendations in clinical guidelines.
Methods
A comprehensive search of MEDLINE (PubMed), Embase, the Cochrane Library, and ClinicalTrials.gov, spanning from inception to April 2024, was conducted to identify all relevant randomized controlled trials (RCTs) that evaluated conservative management of patent ductus arteriosus (PDA) in preterm infants. Conservative management was defined as approximately ≤25% open-label pharmacological treatment with ibuprofen, indomethacin, or paracetamol and/or ligation/endovascular closure. Our primary outcomes were the risk of all-cause mortality and bronchopulmonary dysplasia. We used RevMan 5.4 to pool risk ratios (RRs) under a random-effects model, ensuring a rigorous and reliable analysis.
Results
Our review included 6 RCTs. There was no difference in the risk of mortality (RR 0.83; 95% CI: 0.64-1.08, I² = 0%) and BPD (RR 0.89; 95% CI: 0.76-1.03, I² = 22%) between the conservative management and active treatment groups. The rates of necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity, sepsis, pulmonary hemorrhage, and the need for surgical ligation or transcatheter occlusion were similar between the two groups.
Conclusions
The meta-analysis showed no difference in the risk of all-cause mortality, BPD, or other clinical outcomes between a strategy of conservative management compared to active treatment. These findings support a conservative approach for the management of PDA in preterm infants. Future studies should focus on cost-effectiveness analyses between the two approaches and investigate important subgroups, such as extremely preterm births.