Current practices in the management of hemodynamically significant patent ductus arteriosus

Abstract Objective To describe current practices among neonatologists and cardiologists regarding the diagnosis and management of hemodynamically significant patent ductus arteriosus (hsPDA) in premature infants, with particular focus on the valuation of echocardiographic parameters, use of scoring systems, and availability of treatment modalities. Study design Cross-sectional survey of members of the American Academy of Pediatrics Sections on Neonatal-Perinatal Medicine and Cardiology and Cardiac Surgery, and the Pediheart.net community, regarding approaches to diagnosing and treating hsPDA. Result 422 providers participated. Only 13.5% recommended routine screening echocardiography. Formal scoring systems were rarely used. Agreement on echocardiographic parameter importance was seen in only two of the nine parameters. Reported treatment availability included medical therapy (99%), surgical ligation (74%), and catheter closure (66%). Catheter closure was more frequently preferred than surgical ligation. Of respondents, 315 were neonatologists (estimated response rate 7% of SONPM), and 107 were cardiologists (estimated response rate 5.4% of SOCCS/Pediheart, noting significant membership overlap between these groups). Conclusion Substantial differences exist between neonatologists and cardiologists in the perceived value of echocardiographic markers for hsPDA. Formal scoring systems are infrequently used with wide variation in adoption, and catheter-based occlusion has been rapidly adopted. Greater consensus in PDA assessment and management is needed.