453 - One Duct, Many Paths: National Perspectives on management of hsPDA and Development of "BRONX PDA Protocol"

Publication Number: 3438.453

Priscila Lisboa, OSF Healthcare Children's Hospital of Illinois, East Peoria, IL, United States; manoj Gupta, Children’s Hospital at Montefiore, Bronx, NY, United States; Jinal gada, The Children's Hospital at Montefiore, Bronx, NY, United States; Antonia Gaudig, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Adithya Sivakumar, The Children's Hospital at Montefiore, Bronx, NY, United States; Shantanu Rastogi, The Children's Hospital at Montefiore, Bronx, NY, United States; Elena N. Kwon, Albert Einstein College of Medicine, Port Washington, NY, United States; Melissa Fazzari, Albert Einstein College of Medicine, Bronx, NY, United States; Nicole J. Sutton, 3253531085, New York, NY, United States

Background: Management of hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants remains highly variable, reflecting uncertainty and differing philosophies between neonatologists (Neo) and pediatric cardiologists (PC). Despite decades of research and multiple therapies, no unified national strategy exists. We conducted a national survey to identify practice variation and based on the results we are introducing the Bronx Clinical Scoring System (BCSS), a multidisciplinary framework to standardize and personalize hsPDA management.

Objective: To have a uniform approach to the management of hsPDA in extremely premature neonates.

Design/Methods: An IRB-approved, anonymous 12-item survey was distributed to more than 5,000 U.S. providers, including Neo and PC. The survey assessed screening criteria, treatment preferences, timing of intervention, and perceived risks and benefits of medical, catheter-based, and surgical closure. Responses were analyzed using chi-square testing (p < 0.05 significant).

Results: A total of 491 providers responded, and 462 complete surveys were analyzed (64% Neo, 35% pc). Most respondents, 62%, initiated PDA screening based on clinical conditions rather than postnatal age. Acetaminophen was the preferred first-line agent (43%, n=217), followed by ibuprofen (34%, n=170) and indomethacin (23%, n=115). Twenty-six percent (n=235) treated hsPDA within the first week of life, 30% (n=273) treat during the second week if clinical signs persist, and 29% (n=265) favor conservative management even when echocardiographic hsPDA is present with low clinical concern. Twelve percent (n=105) defer closure until after one month of life. Marked specialty differences emerged, as 76% of PC compared with 27% of Neos believe PDA closure reduces morbidity and mortality, yet both groups reported high treatment rates (74% vs 64%). Neos preferred medical and percutaneous closure over surgical ligation.

Conclusion(s): This national survey highlights striking variability in hsPDA management and the need for a cohesive, evidence-informed approach. So many Neos are moving away from treating hsPDA in first 2 weeks of life and there is a shift towards targeted individualized care. The BCSS was developed in response to these findings as a multidisciplinary tool integrating clinical and echocardiographic criteria to guide management decisions beyond two weeks of life. The BCSS promotes standardized, structured, and collaborative decision-making tools, supporting multidisciplinary care in alignment with AAP guidance and representing a practical step toward standardization in hsPDA management.

Morbidity and Mortality associated with PDA
Specialty variation in perceived MnM

Bronx Clinical Scoring system
Clinical and echocardiographic scoring tool

Bronx PDA management algorithm
hs PDA management steps