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Procedural closure of the patent ductus arteriosus in preterm infants: a clinical practice guideline

Journal of Perinatology volume 44, pages 1402–1408 (2024)Cite this article

Subjects

Abstract

Importance

Transcatheter closure of the patent ductus arteriosus (PDA) is being increasingly adopted as an alternative to surgical PDA closure in preterm infants.

Objective

To develop rigorous clinical practice guideline recommendations on procedural PDA closure in preterm infants.

Methods

The principles of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Evidence-to-Decision (EtD) framework were used to develop the guideline recommendations. An e-Delphi survey of 45 experts was conducted and recommendations that reached ≥75% agreement were accepted as consensus.

Main recommendations

Procedural PDA closure may be considered in extremely preterm infants (<28 weeks gestational age) requiring invasive mechanical ventilation >10 postnatal days and confirmed to have a large hemodynamically significant PDA, at centers with high local rates of death and/or bronchopulmonary dysplasia (conditional recommendation). If sufficient institutional expertise is available and patient characteristics are suitable, transcatheter PDA closure may be considered as the preferred approach over PDA ligation (conditional recommendation).

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Fig. 1: Summary of recommendations.

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Author information

Author notes

  1. These authors contributed equally: Souvik Mitra, Adrianne R. Bischoff.

Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, Canada

    Souvik Mitra

  2. Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, USA

    Adrianne R. Bischoff & Patrick J. McNamara

  3. Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA

    Shyam Sathanandam

  4. Department of Pediatrics, UC Davis Children’s Hospital, Sacramento, CA, USA

    Satyan Lakshminrusimha

Authors
  1. Souvik Mitra
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  2. Adrianne R. Bischoff
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  3. Shyam Sathanandam
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  4. Satyan Lakshminrusimha
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  5. Patrick J. McNamara
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Contributions

SM developed the clinical practice guideline outline, summarized the evidence, co-chaired the panel meetings, prepared the draft recommendations, wrote the manuscript draft. ARB created and distributed the e-Delphi survey, collated and analyzed the results, participated in the panel meetings, reviewed all drafts, and approved the final version of the manuscript. SS participated in the panel meetings, reviewed all drafts, and approved the final version of the manuscript. SL participated in the panel meetings, created the summary of recommendations figure, reviewed all drafts, and approved the final version of the manuscript. PJM conceived the project, chaired the panel meetings, reviewed all drafts, and approved the final version of the manuscript.

Corresponding author

Correspondence to Patrick J. McNamara.

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Competing interests

S. Sathanandam: proctor/consultant Abbott. Other authors do not have any conflicts to disclose.

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Mitra, S., Bischoff, A.R., Sathanandam, S. et al. Procedural closure of the patent ductus arteriosus in preterm infants: a clinical practice guideline. J Perinatol 44, 1402–1408 (2024). https://doi.org/10.1038/s41372-024-02052-9

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