Decrease in the frequency of treatment for patent ductus arteriosus after implementation of consensus guidelines: a 15-year experience

Patent ductus arteriosus (PDA) management varies widely among neonatologists. Lack of institution-specific evidence-based guidelines for therapeutic closure of PDA. Quality improvement project among infants <30 weeks gestational age (GA) designed to determine whether the odds of therapy for closing the PDA, adjusted for GA, decreased after implementing evidence-based guidelines. Implementation of guidelines with conservative approach to PDA management. The frequency of PDA treatment decreased from 446/1125 (40%) in Epoch 1 to 96/482 (20%) in Epoch 2. PDA treatment was more frequent in neonates 23–26 weeks GA than those of 27–29 weeks GA (43% vs. 28%, respectively). Among 542 infants receiving indomethacin for PDA, 25% had subsequent ligation; the odds of ligation after indomethacin were lower in neonates 27–29 weeks GA and decreased during Epoch 2. The frequency of medical and surgical treatment for therapeutic closure of PDA decreased after implementing evidence-based treatment guidelines.