TY - JOUR
T1 - Expectant Management vs Medication for Patent Ductus Arteriosus in Preterm Infants
T2 - The PDA Randomized Clinical Trial
AU - Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
AU - Laughon, Matthew M.
AU - Thomas, Sonia M.
AU - Watterberg, Kristi L.
AU - Kennedy, Kathleen A.
AU - Keszler, Martin
AU - Ambalavanan, Namisavayam
AU - Davis, Alexis S.
AU - Slaughter, Jonathan L.
AU - Guillet, Ronnie
AU - Colaizy, Tarah T.
AU - Cotten, C. Michael
AU - Dhawan, Megan A.
AU - Bose, Carl L.
AU - Talbert, Jennifer
AU - Smucny, Sarah
AU - Benitz, William E.
AU - Rysavy, Matthew A.
AU - Ohls, Robin K.
AU - Baserga, Mariana C.
AU - Demauro, Sara B.
AU - Jaleel, Mambarambath
AU - Jackson, Wesley M.
AU - Carlo, Waldemar A.
AU - Puopolo, Karen M.
AU - Hibbs, Anna Maria
AU - Katheria, Anup
AU - Sánchez, Pablo J.
AU - D'Angio, Carl T.
AU - Patel, Ravi M.
AU - Johnson, Beth Ann
AU - Chock, Valerie Y.
AU - Bhatt, Abhay J.
AU - Merhar, Stephanie L.
AU - Moore, Ryan
AU - Laptook, Abbot R.
AU - Ghavam, Sarvin
AU - Fuller, Janell
AU - Vyas-Read, Shilpa
AU - Kicklighter, Stephen D.
AU - Steinbrekera, Baiba
AU - Anderson, Kathryn
AU - Reynolds, Anne Marie
AU - Wyckoff, Myra H.
AU - Montoya, Cassandra
AU - Das, Abhik
AU - Do, Barbara
AU - Chang, Samantha
AU - Higgins, Rosemary D.
AU - Walsh, Michele C.
N1 - Publisher Copyright:
© 2026 American Medical Association.
PY - 2025
Y1 - 2025
N2 - Importance: The management of patent ductus arteriosus (PDA) in preterm infants is controversial. Objective: To determine whether expectant management compared with active treatment of a protocol-defined PDA in preterm infants decreases the incidence of death or bronchopulmonary dysplasia (BPD). Design, Setting, and Participants: A randomized clinical trial including infants born at 22 to 28 weeks' gestation and diagnosed with a protocol-defined PDA between the age of 48 hours and 21 days at screening. The trial was conducted from December 2018 to December 2024 at 33 hospitals within the National Institute of Child Health and Human Development Neonatal Research Network. The final date of follow-up was June 2025. Interventions: Infants with PDA were randomized to expectant management (n = 242) or active treatment (n = 240; acetaminophen, ibuprofen, or indomethacin) to close the PDA. Main Outcomes and Measures: The primary outcome was death or BPD at 36 weeks' postmenstrual age. The secondary outcomes included the components of the primary outcome and other morbidities of prematurity. Results: A total of 482 infants were randomized (median gestational age, 25 weeks [IQR, 24 to 27 weeks]; median birth weight, 760 g [IQR, 620 to 935 g]). The trial was stopped for futility and safety after the 50% interim analysis for the primary outcome due to higher survival in the expectant management group. The incidence of death or BPD was 80.9% (195/241) of infants in the expectant management group vs 79.6% (191/240) of infants in the active treatment group (adjusted risk difference, 1.2% [95% CI, -5.7% to 8.1%]; P =.73). The incidence of death before 36 weeks' postmenstrual age was 4.1% (10/241) of infants in the expectant management group vs 9.6% (23/240) of infants in the active treatment group (adjusted risk difference, -5.6% [95% CI, -10.1% to -1.2%]; P =.01). Infections resulting in death occurred in 0.8% (2/241) of infants in the expectant management group vs 3.8% (9/240) of infants in the active treatment group. Conclusions and Relevance: In extremely preterm infants with a protocol-defined PDA, death or BPD did not differ between the expectant management group and the active treatment group. Survival was substantially higher with expectant management. Trial Registration: ClinicalTrials.gov
AB - Importance: The management of patent ductus arteriosus (PDA) in preterm infants is controversial. Objective: To determine whether expectant management compared with active treatment of a protocol-defined PDA in preterm infants decreases the incidence of death or bronchopulmonary dysplasia (BPD). Design, Setting, and Participants: A randomized clinical trial including infants born at 22 to 28 weeks' gestation and diagnosed with a protocol-defined PDA between the age of 48 hours and 21 days at screening. The trial was conducted from December 2018 to December 2024 at 33 hospitals within the National Institute of Child Health and Human Development Neonatal Research Network. The final date of follow-up was June 2025. Interventions: Infants with PDA were randomized to expectant management (n = 242) or active treatment (n = 240; acetaminophen, ibuprofen, or indomethacin) to close the PDA. Main Outcomes and Measures: The primary outcome was death or BPD at 36 weeks' postmenstrual age. The secondary outcomes included the components of the primary outcome and other morbidities of prematurity. Results: A total of 482 infants were randomized (median gestational age, 25 weeks [IQR, 24 to 27 weeks]; median birth weight, 760 g [IQR, 620 to 935 g]). The trial was stopped for futility and safety after the 50% interim analysis for the primary outcome due to higher survival in the expectant management group. The incidence of death or BPD was 80.9% (195/241) of infants in the expectant management group vs 79.6% (191/240) of infants in the active treatment group (adjusted risk difference, 1.2% [95% CI, -5.7% to 8.1%]; P =.73). The incidence of death before 36 weeks' postmenstrual age was 4.1% (10/241) of infants in the expectant management group vs 9.6% (23/240) of infants in the active treatment group (adjusted risk difference, -5.6% [95% CI, -10.1% to -1.2%]; P =.01). Infections resulting in death occurred in 0.8% (2/241) of infants in the expectant management group vs 3.8% (9/240) of infants in the active treatment group. Conclusions and Relevance: In extremely preterm infants with a protocol-defined PDA, death or BPD did not differ between the expectant management group and the active treatment group. Survival was substantially higher with expectant management. Trial Registration: ClinicalTrials.gov
UR - https://www.scopus.com/pages/publications/105024355897
U2 - 10.1001/jama.2025.23330
DO - 10.1001/jama.2025.23330
M3 - Article
C2 - 41364689
AN - SCOPUS:105024355897
SN - 0098-7484
JO - JAMA
JF - JAMA
ER -