Early protocol-based echocardiographic assessment and management of patent ductus arteriosus in infants less than 29 weeks’ gestation

A protocol-based PDA screening pathway using early TnECHO was associated with lower adjusted odds of BPD and major IVH, reduced invasive ventilation days and no increase in PDA treatment, without a change in mortality. Because pre versus post observational designs remain susceptible to residual confounding and secular practice changes, findings should be interpreted as associations rather than causal effects. Prospective multicentre evaluations using standardised echocardiographic criteria are needed to assess pathway impact and inform PDA screening strategies.