Pharmacologic treatment strategies and association with major neonatal outcomes for patent ductus arteriosus in preterm infants
Background Patent ductus arteriosus (PDA) is common in preterm infants. Although pharmacologic treatment promotes ductal closure, its impact on clinically meaningful outcomes remains uncertain. This study aimed to evaluate the association between different pharmacologic PDA treatment strategies and major neonatal outcomes. Methods This retrospective cohort study included preterm infants born at <32 weeks’ gestation who received pharmacologic treatment for clinically significant PDA following an integrated echocardiographic and clinical assessment in a tertiary-level neonatal intensive care unit between 2018 and 2024. Infants were categorized by treatment strategy (ibuprofen only, paracetamol only, or sequential therapy), treatment timing, and number of treatment courses. The primary outcome was a composite of bronchopulmonary dysplasia (BPD) and/or mortality. Secondary outcomes included intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity, and sepsis. Results A total of 76 preterm infants were included, with a median gestational age of 28 weeks (IQR 26–30) and mean birth weight of 1,076 ± 343 g. Infants were treated with ibuprofen only (n = 31, 40.8%), paracetamol only (n = 27, 35.5%), or sequential therapy (n = 18, 23.7%). The composite outcome occurred in 39 infants (51.3%) and did not differ significantly across treatment groups. In multivariate analysis, gestational age emerged as the strongest independent predictor of BPD and/or mortality (adjusted OR 0.54, 95% CI 0.38–0.77; p = 0.001), while treatment category was not independently associated with outcomes. Conclusion Pharmacologic PDA treatment strategies were not independently associated with BPD and/or mortality in this retrospective cohort. Gestational age showed the strongest association with the primary outcome; however, residual confounding and limited statistical power preclude causal or equivalence conclusions.