Can early serum NT-proBNP levels predict the need for PDA surgery?

Patent ductus arteriosus (PDA) is a common remnant of fetal circulation in preterm infants which can have a significant impact on respiratory and cardiovascular morbidity in these infants and can also increase rates of necrotising enterocolitis (NEC), intraventricular haemorrhage (IVH), cause impaired renal function and increase rates of overall mortality. 1 There is a large variation in practice across neonatal units with regards to management of a PDA. In general, a PDA can be managed actively or expectantly. Active management can include medication to close the duct such as paracetamol or ibuprofen, duct device closure in the catheterisation lab or duct ligation via thoracotomy. Expectant management usually involves managing symptoms of pulmonary over circulation of a PDA whilst monitoring duct size and flow, as most PDAs will spontaneously restrict and close with time. The evidence is still unclear about whether active management or expectant management is superior in reducing morbidity and mortality in this vulnerable cohort of infants. The evidence is also unclear regarding which infants would most benefit from earlier PDA closure, and there is no universal scoring system in place for determining this. In 2025, Masutani et al. generated a scoring system for use in infants less than 30 weeks gestation to predict their need for PDA surgery. The patent ductus arteriosus and left atrial size evaluation (PLASE) score used post-hoc analysis of 710 preterm infants to create this predictive model; and the final scoring system uses gestational age and 3 echocardiographic indices to predict need for PDA surgery, with an ROC-AUC of 0.846 [95% CI, 0.805–0.886]. 2