Trends in transcatheter and operative closure of patent ductus arteriosus in neonatal intensive care units: Analysis of data from the pediatric health information systems database

Abstract Background The risks and benefits of pharmacologic treatment and operative closure of patent ductus arteriosus (O-PDA) in premature infants remain controversial. Recent series have demonstrated the feasibility of transcatheter PDA closure (TC-PDA) in increasingly small infants. The effect of this change on practice has not been evaluated. Methods A multicenter observational study of infants treated in neonatal intensive care units in hospitals contributing data to the Pediatric Health Information Systems Database from 1/2007–12/2017 was performed to study trends in the propensities for 1) mechanical closure of PDA and 2) TC-PDA vs. O-PDA, as well as inter-hospital variation in practice. Results A total of 6214 subjects at 44 hospitals were studied (5% TC-PDA). Subject median gestational age was 25 weeks (IQR: 24–27 weeks). Median age at closure was 24 days (IQR: 14–36 days). The proportion of all NICU patients undergoing either O-PDA or TC-PDA decreased (3.1% in 2007 and 0.7% in 2017, P  Conclusion In the face of decreasing closure of PDA, the use of TC-PDA increased dramatically with significant practice variability. This demonstrates that there is equipoise for potential clinical trials.