Active Treatment vs Expectant Management of Patent Ductus Arteriosus in Preterm Infants: A Meta-Analysis
Abstract
Importance: Recent evidence suggests that expectant management of hemodynamically significant patent ductus arteriosus (PDA) may confer better outcomes.
Objective: To assess clinical outcomes of active treatment vs expectant management of hemodynamically significant PDA in preterm infants.
Data sources: The PubMed (MEDLINE), Embase, and Cochrane Library databases were searched for randomized clinical trials (RCTs) published between January 1, 2010, and July 31, 2024.
Study selection: RCTs were included if they enrolled preterm infants born before 33 weeks of gestation and had 2 groups comparing active treatment with expectant management.
Data extraction and synthesis: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was followed. Data were extracted by 2 independent reviewers. The Cochrane Risk of Bias tool was used to assess study quality. A random-effects model was used to estimate the pooled effects.
Main outcomes and measures: The primary outcomes were a composite of death at 36 weeks' postmenstrual age or at discharge (whichever occurred later) or moderate to severe bronchopulmonary dysplasia (BPD), death at 36 weeks, and moderate to severe BPD. Secondary outcomes included intraventricular hemorrhage, periventricular leukomalacia (PVL), retinopathy of prematurity, and necrotizing enterocolitis.
Results: This meta-analysis included 10 RCTs involving 2035 infants. There were 1018 infants in the active treatment group (510 female [50.1%])…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,018 participants or records.
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